Emsen Ilteris Murat
Department of Plastic Reconstructive and Aesthetic Surgery, Numune State Hospital, Erzurum, Turkey.
J Craniofac Surg. 2008 Jan;19(1):216-26. doi: 10.1097/scs.0b013e31815c9477.
Correction of the crooked or deviated nose, a complex cosmetic and functional problem, is a challenge for the rhinoplasty surgeon. Although corrections using a wide range of surgical techniques to straighten the nose and maximize nasal function have been proposed, recurrence is very common because of cartilage memory and scar contracture. Therefore, to prevent recurrence and to maintain the correction of the septum, a stable, strong, and permanent support is needed with the ability to maintain its given shape after placement on one or both sides of the septum. For this purpose, the author planned to use a personally-shaped graft (EMSEN) with high-density porous polyethylene (Medpor, Porex Surgical Inc., Newnan, GA). In this study, the concept and technique of Medpor, composed of a nonresorbable alloplastic material for correction of the crooked nose, and the authors' experience using it, are presented. Currently, Medpor is readily available on the market as a thin plain sheet (0.85 x 38 x 50 mm) that can be cut to an appropriate size for our (EMSEN) grafts. Ingrowths of fibrous tissue inside and around Medpor stabilize the upper lateral cartilages and septum in their newly corrected position and maintain the corrected/straightened position. This material was used in 18 patients with crooked noses (7 with C-type and 11 with S-type noses). During a mean follow-up period of 20 months (range, 10-50 months), there were no complications, recurrences, or extrusions. Functional evaluation was performed using a visual analog scale before surgery and 6 months after surgery. Patients were asked to score their nasal breathing on a scale ranging from 0 to 100. The mean preoperative value was 17.78% +/- 1.23% (range, 15-25%), and the postoperative value was 86.67% +/- 1.21% (range, 80-95%). In conclusion, the use of EMSEN with Medpor grafts is a safe, effective, reliable, and permanent method for correction of the crooked nose. In the long term, the authors believe that EMSEN grafts provide functional recovery and increased strength against further trauma or forces of scar contracture, and have the ability to prevent recurrence attributable to cartilage memory.
矫正歪鼻或鼻中隔偏曲是一个复杂的美容和功能问题，对鼻整形外科医生来说是一项挑战。尽管已经提出了使用多种手术技术来矫正鼻子并最大化鼻腔功能，但由于软骨记忆和瘢痕挛缩，复发非常常见。因此，为了防止复发并维持鼻中隔的矫正，需要一种稳定、坚固且永久的支撑物，该支撑物在放置于鼻中隔一侧或两侧后能够保持其给定的形状。为此，作者计划使用一种个人定制的移植物（EMSEN），其材料为高密度多孔聚乙烯（Medpor，Porex Surgical Inc.，美国佐治亚州纽南市）。在本研究中，介绍了由不可吸收的异体材料制成用于矫正歪鼻的Medpor的概念和技术，以及作者使用它的经验。目前，Medpor在市场上很容易买到，是一种薄的平板（0.85×38×50毫米），可以切割成适合我们（EMSEN）移植物的合适尺寸。Medpor内部和周围的纤维组织向内生长，将上外侧软骨和鼻中隔稳定在其新矫正的位置，并维持矫正/伸直的位置。该材料用于18例歪鼻患者（7例C型鼻和11例S型鼻）。在平均20个月（范围10 - 50个月）的随访期内，未出现并发症、复发或排斥反应。在手术前和手术后6个月使用视觉模拟量表进行功能评估。要求患者对其鼻腔通气情况在0至100的范围内评分。术前平均值为17.78%±1.23%（范围15 - 25%），术后值为86.67%±1.21%（范围80 - 95%）。总之，使用EMSEN和Medpor移植物是一种安全、有效、可靠且永久性的矫正歪鼻方法。从长远来看，作者认为EMSEN移植物可实现功能恢复，并增强抵抗进一步创伤或瘢痕挛缩力的能力，且有能力预防因软骨记忆导致的复发。
