The Nasal Swell Body and Septal Perforation Repair

Ghorab, Saba; Taylor, Cullen M.; Bansberg, Stephen F.

doi:10.1002/lary.28621

Cited by 14 publications

(25 citation statements)

References 19 publications

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“…Perforation repairs utilizing bilateral nasal mucosal flaps with an interposition graft have the theoretical advantage, over other techniques, of using both physiologic nasal mucosa and a third tissue layer as a barrier to re-perforation. Various interposition graft materials have been successfully used and include temporalis fascia, 5,7,10 temporoparietal fascia, 2,3 costal perichondrium, 4 cartilage (septal, auricular, costal), 1,5 septal bone, human acellular dermis, 11 and porcine small intestine submucosa. 12 Kridel and Delaney 13 opined that the choice of graft material was less important to repair success than the achievement of a bilateral, tension-free closure.…”

Section: Discussionmentioning

confidence: 99%

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Auricular Perichondrium Graft for Septal Perforation Repair

Bansberg

Taylor

Neel

2021

Ann Otol Rhinol Laryngol

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Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

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Section: Discussionmentioning

confidence: 99%

“…Septal perforation repair is performed endonasally through a right hemitransfixion incision. 6,7 Mucoperichondrial/periosteal elevation is performed bilaterally. The extent of elevation and incision placement for bipedicle flap development is determined by perforation size and position.…”

Section: Methodsmentioning

confidence: 99%

Auricular Perichondrium Graft for Septal Perforation Repair

Bansberg

Taylor

Neel

2021

Ann Otol Rhinol Laryngol

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“…The senior author performed all perforation repairs with a technique using bilateral mucosal flaps with an autogenous interposition graft. 4,5 The open approach was used early in this experience for selected perforations. Subsequently, all repairs were performed through an endonasal approach.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Septal Perforation Repair With Concurrent Endoscopic Sinus Surgery

Abdel-Aty

Cain²,

Taylor

et al. 2021

Otolaryngol.--head neck surg.

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Objective This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported. Study Design Case series. Setting Tertiary care center. Methods In this institutional review board–approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up. Results Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs. Conclusion Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.

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“…18 A recent retrospective study found that repairing SPs with bilateral mucosal flaps may cause persistent postoperative nasal congestion due to NSB and that nasal congestion in these patients may be relieved by the surgical reduction of NSB without reperforation. 10 Application of isolated topical decongestants in NSB can determine whether surgery is needed and help predict nasal patency after surgery. 41 A silastic sheet was cut into the shape and size of the anterior nasal cavity.…”

Section: Surgical Attemptsmentioning

confidence: 99%

“…5,6 The NSB has been a surgical target of interest and hence surgical procedures have also been attempted to reduce its volume in recent years. [7][8][9][10] Nevertheless, the structure and function of NSBs are still far less understood. 11,12 Therefore, we endeavored to produce a precise contemporary description to improve our understanding of NSB.…”

Section: Introductionmentioning

confidence: 99%

Nasal Septal Swell Body: A Distinctive Structure in the Nasal Cavity

Meng¹,

Zhu

2021

Ear Nose Throat J

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Objectives: The nasal septal swell body (NSB), also known as the nasal septal turbinate, is located in the anterior part of the nasal septum. This study is a narrative review of the existing knowledge on recent developments in NSB. Methods: A literature search was performed using PubMed, Embase, Web of Science, Ovid, and Cochrane Library databases. Google Scholar was used to access more extensive literature. The inclusion criteria were human studies published in English. The exclusion criteria were non-English language and animal studies. Results: Of the 345 articles that were initially obtained from 5 databases and Google Scholar, 28 were included in this review. There have been many names for NSBs in the past, which still have no unified terminology recognized by professionals. Pathological investigations revealed that NSB contains a certain amount of sinusoidal blood components. Nasal septal swell body is closely related to the internal nasal valve. Imaging studies have found that the size of NSB is associated with nasal diseases, and NSB hypertrophy can cause anatomic obstruction. In recent years, several procedures for NSB have been reported, and preliminary effectiveness has been achieved. However, the long-term outcomes of volume reduction techniques remain unproven. Conclusions: The NSB is a distinct anatomic structure that may contribute to nasal obstruction and may be reduced surgically with unclear long-term results. Although being investigated for over a century, the unique physiological roles of NSB are not yet fully understood. More evidence is needed to elucidate its physiological effects.

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The Nasal Swell Body and Septal Perforation Repair

Cited by 14 publications

References 19 publications

Auricular Perichondrium Graft for Septal Perforation Repair

Auricular Perichondrium Graft for Septal Perforation Repair

Outcomes of Septal Perforation Repair With Concurrent Endoscopic Sinus Surgery

Nasal Septal Swell Body: A Distinctive Structure in the Nasal Cavity

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