Although unsintered hydroxyapatite and poly-l-lactic acid (u-HA/PLLA) composite sheets have various applications, such as in craniomaxillofacial fractures, orthognathic surgery, and orthopedic surgery, and have been proven to be safe and effective, no studies have reported the use of u-HA/PLLA composite sheets for orbital wall reconstruction with long-term follow-up. This study reports our preliminary results using the u-HA/PLLA composite sheet for orbital wall fractures. The SuperFIXSORB MX sheet (u-HA/PLLA composite sheet; Takiron, Tokyo, Japan), with size of 30 × 50 mm and thickness of 0.5 mm, was used in all cases of hard reconstruction of the orbital bone defect. Seventy-two patients with acute orbital wall fractures (within 2 weeks after sustaining the injury) treated at the Jikei University between January 2014 and August 2016 were included. The authors evaluated the postoperative complications and the operability of the material. The authors did not observe any postoperative complications, such as infection, postoperative diplopia, or enophthalmos, due to the use of the u-HA/PLLA composite sheet. In pure orbital fractures (orbital fractures only), the mean (±standard deviation) operation time was significantly longer with combined inferior and medial wall fractures (201.1 ± 36.6 minutes; n = 11) than with inferior wall or medial wall fractures only (135.0 ± 54.4 minutes; n = 51) (Mann–Whitney U test, P < 0.001). The U-HA/PLLA composite sheet is safe and can be used for orbital wall fracture reconstruction. Further long-term functional and aesthetic assessments for infection, ocular movement disorder, enophthalmos, and any other complication are necessary.

We have used the technique of open septorhinoplasty since in combined surgery in collaboration with ENT surgeons, as to improve nasal function and esthetics. This approach covers a wide variety of nasal pathologies including nasal valve obstruction, post-traumatic nasal obstruction, caudal septal deviation, and post-conventional septoplasty with worsening of nasal obstruction. Here, we describe the importance of manipulating the caudal septum in treatment of caudal septal deviation. Operation: Thorough a transcolumellar incision with infra-cartilagenous extension, the interdomal ligament was divided to approach the anterior angle of the septal cartilage to obtain access for sub-mucoperichondrial dissection. Septoplasty and conchal surgery are performed as needed by an ENT surgeon. If caudal deviation is moderate, it can be straightened by freeing the septum from the upper lateral cartilages. If the posterior angle of the septum is dislodged from the anterior nasal spine ANS , the posterior septal angle is freed, trimmed and sutured to the ANS. If the posterior septal angle is toward the ANS, the length of the caudal septum can be adjusted in the middle and reinforced with a batten graft. Discussion: The pathologies of the anterior septal angle without dislocation from the anterior nasal spine are relative overload on the caudal septum from the dorsal cartilaginous component of the nose, which includes a frail septum, misbalance of the septal cartilage and surrounding bony structures, and intrinsic torsional memory of the cartilage. If septal cartilage is dislodged from the ANS, the pathology is more likely to be due to a previous trauma. Understanding the pathology of caudal septal deviation is essential in straightening and centralizing the septal cartilage.