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.

Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series

Objective: Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain. Method: The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms. Results: Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic. Conclusions: This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.

Biomaterials in the Reconstruction of Nasal Septum Perforation

Introduction: Septal perforations are among the most common craniofacial defects. The causes of septal perforations are varied. Objectives: The purpose of the study was to develop a septal cartilage implant biomaterial for use in the reconstruction of nasal septal perforations and prepare personalized implants for each patient individually using 3D printing technology. Methods: Fragments of septal nasal cartilage from 16 patients undergoing surgery for a deviated nasal septum were analyzed to establish microfeatures in individual samples. A scanning electron microscope was used to estimate the microstructure of the removed septal cartilage. 3D models of porous scaffolds were prepared, and a biomaterial was fabricated in the shape of the collected tissue using a 3D printer. Results: Of the various materials used in the Fused Deposition Modeling (FDM) technology of 3D printing, PLLA was indicated as the most useful to achieve the expected implant features. The implant was designed using the indicated pre-designed shape of the scaffold, and appropriate topography, geometry and pore size were included in the design. Conclusions: The implant’s structure allows the use of this device as a framework to carry nanoparticles (antibiotics or bacteriophages). It is possible to create a porous scaffold with an appropriately matched shape and a pre-designed geometry and pore size to close nasal septal perforations even in cases of large septal cartilage defects.