Prevention of Septal Perforation Using a Combination of Crushed Cartilage and Thin Silastic Sheet During Septoplasty

Background and Objectives: The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty.Materials and Methods: A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed.Results: Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications.Conclusion: This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.

Nasal Septal Perforation Closure by “Sandwich Grafts”: Technique, Initial Results

Nasal septal perforation closure represents a considerable surgical challenge. Many techniques rely on the implantation of foreign materials that pose a persisting threat of infection. The authors have identified a reliable technique closing septal perforations by an autologous “sandwich graft.” It is layered around a piece of auricular cartilage, covered with temporal fascia, thus emulating the physiological layers of the nasal septum. Finally, the prepared graft is then sewn into the perforation in an underlay technique and kept in place by septal splints for 4 weeks. The technique is easily feasible and strives to reconstruct the nasal as physiological as possible. The data obtained from a case series of 11 patients highlights the efficacy of the technique.

Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft

Background Various graft materials have been used to repair nasoseptal perforation, but there is no standardized treatment method. The anterior maxillary sinus wall is flattened in appearance and can be easily obtained in a sufficient amount for a large-sized nasoseptal perforation. Objectives The aim of this study is to determine whether the anterior maxillary sinus wall is suitable as an interpositional graft in the surgical repair of septal or nasoseptal perforation. Methods This is a retrospective review of 21 patients who underwent repair of nasoseptal perforation using anterior maxillary sinus wall as an interpositional graft. The etiology, pre- and post-operative NOSE and GBI score, and perforation size were reviewed. The surgical outcome was considered successful if total closure was achieved after postoperative follow-up. Results 19 of the 21 perforations were successfully repaired with anterior maxillary sinus wall. Failure of the repair was found in 2 patients. Causal etiology of perforation was previous septoplasty in 10 patients, and electrocautery in 1 case, but not identified in 10 cases. The largest size was 2.7 × 2.2 cm. The most common symptoms were epistaxis, crusting, and nasal obstruction. Closure of septal perforation resulted in improved subjective symptoms and quality of life which were evaluated with NOSE and GBI score. Conclusion Anterior maxillary sinus wall as interpositional graft between mucoperichondrial flaps can be used to reliably repair nasoseptal perforations.

Horizontal dorsal resection of a crooked septum in septoplasty

Objective: There are several types of septal deviation, including horizontal, vertical, C-shaped, S-shaped, and high deviation. One of the most difficult of these types to correct is the crooked dorsal septum, which attaches to the upper lateral cartilage and causes a high septal deviation. We propose a method for horizontal dorsal resection of a crooked septum using a mucosal through-and-through suture technique for the correction of high septal deviation. Design and setting: The medical records of 30 patients (27 men) who underwent septoplasty by one author of this study from 2019 to 2020 at our institute were reviewed prospectively. The median follow-up was 11 months (range, 4–16 months). All patients underwent a horizontal dorsal septal cartilaginous resection with mucosal through-and-through suture. Data were collected on demographics, symptoms, anatomic site of deviation, and postoperative complications. Patient self-satisfaction scores were subjectively graded using a visual analog scale ranging from 0 (excellent) to 10 (poor). Results: One surgeon performed each septoplasty using the same method; 2 (6.7%) patients underwent additional valvuloplasty. The median scores in subjective satisfaction for the 30 patients were 8.4±1.22 before surgery and 2.07±1.26 after surgery (p<0.05). Furthermore, no patient experienced a saddle deformity, septal hematoma, septal perforation, or loss of nasal tip support during follow-up. Conclusions: After horizontal dorsal resection from the upper lateral cartilage during septoplasty, the patients experienced no stability problems. This suggests that this surgical technique is a safe and effective method for correcting high deviation due to a crooked dorsal septum.