Polyethylene Implants in Nasal Septal Restoration

Abstract

eptal perforation (SP) is a common nasal disorder. A 2003 Swedish study 1 quoted a 0.9% prevalence of SP among the general population. The origin of SP is associated with the following 4 main causes: trauma, iatrogenesis, inflammation or malignancy, and inhalation. 2 Once the mucoperichondrium of the nasal septum becomes traumatized, diminished blood supply can lead to cartilaginous and mucosal necrosis. 3 Local reepithelialization of the mucosal edges then occurs, preventing closure of the defect. 4 Patients with SP may be seen with various symptoms and signs that often correspond to the size and location of the SP. An asymptomatic SP does not require any intervention. 5 Most symptomatic SPs are large and anterior, while posterior SPs tend to be less symptomatic due to humidification of the passing air by nasal mucosa and turbinates. 3 Common symptoms include nasal crusting, discharge, epistaxis, parosmia, neu-ralgia, and a whistling sound with inspiration. Some patients may manifest low-grade perichondritis, requiring long-term antibiotic therapy. Larger long-standing SPs can also cause atrophic rhinitis and saddle nose from a lack of nasal dorsal support. 2,6,7 Despite their being a common problem, SPs have been a distinctive challenge for otolaryngologists and facial plastic surgeons. Various techniques have been described to close SPs, and no single technique is recognized as being uniformly reliable in applying to all cases. 2 Furthermore, SP repair is often performed in noses that have already undergone surgery and have limited tissue and a compromised blood supply for reconstruction. Therefore, most SPs remain unclosed because available techniques are technically difficult and require extensive training and experience to master. IMPORTANCE Numerous techniques have been described to repair nasal septal perforations (SPs). However, many are technically challenging, with varying degrees of success. OBJECTIVE To evaluate the use of polyethylene (Medpor; Porex Technologies) implants in the closure of nasal SPs. DESIGN AND SETTING Prospective cohort study in an academic research setting.

A new classification for septal perforation and effects of treatment methods on quality of life

“… 10 , 29 In fact, it has been reported in the literature that it is possible to completely cover the perforation site with polyethylene implants and the mucosa will advance over this implant to heal the perforation. 30 We used septal cartilage or perpendicular plate of ethmoid bone (when septal cartilage was not available) in our cases and achieved a 95% success rate, which is consistent with the literature. We think that the problem in the patient who cannot close the perforation is originating from impaired nutrition.…”

Care of the Cocaine User with Nasal Deformity

“…51 In a similar vein, the cartilage defect of a septal perforation may almost always be reconstructed using autologous materials such as conchal cartilage and rib. 46 Foreign materials used as interposition grafts have included xenografts (e.g., porcine intestine 52 ) and synthetic materials (e.g., mesh made from titanium or polyethylene 53,54 ), but there are far fewer large scale case series using foreign materials than autologous grafts. The overriding conclusion from our experience of septal perforation repair is that patient selection is the crucial step in operative planning-in selecting patients who are intractably symptomatic from their perforation despite palliative treatment; who will adhere to health behaviors, which optimize the condition of the mucosa; and with perforations of less than 1 cm.…”

Upper lateral cartilage composite flap for closure of complicated septal perforations

“…Surgical approaches for septal perforation repair include endonasal surgery, with or without endoscopic assistance, open rhinoplasty, and sublabial and even facial degloving techniques. Previously described techniques for repairing septal perforations include the use of inferior turbinate flaps, bipedicled mucoperichondrial advancement flaps with accompanying interposition supporting grafts formed from various materials, buccal flaps, facial artery musculomucosal flaps, intranasal tissue expansion and tissue transfer, pericranial rotation flaps, use of resorbable implants and composite cartilage grafts with secondary mucosal migration, and even radial forearm free flaps with microvascular anastomoses . Recruiting extranasal flaps introduces nonrespiratory mucosa into the nose and is associated with a second donor site.…”