Toriumi Dean M, Cappelle Quintin M, Chung Victor
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago2Associate editor, JAMA Facial Plastic Surgery.
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago.
JAMA Facial Plast Surg. 2017 Mar 1;19(2):121-127. doi: 10.1001/jamafacial.2016.1367.
Closure of septal perforations remains a technically difficult procedure to perform.
To assess the use of costal perichondrium as an interpositional graft to enhance closure of septal perforations using bilateral mucosal flaps and the effectiveness of the procedure.
DESIGN, SETTING, AND PARTICIPANTS: This case series included all 51 consecutive patients presenting with septal perforations from January 1, 2006, to August 31, 2014, at a single institution. Mean (SD) follow-up was 19 (18) months. Patients with subtotal perforations did not have their perforations closed but underwent rhinoplasty with improved form and function. All patients underwent evaluation for changes in postoperative symptoms.
Bipedicled mucoperichondrial flaps with placement of costal perichondrium between the repaired flaps.
Success rate of septal perforation closures and the clinical impact of the success of closure as experienced by the patient using the validated Nasal Obstruction Symptom Evaluation (NOSE) questionnaire (range, 0-20; higher scores indicate greater obstruction).
Of the 51 patients (14 male; 37 female; median age, 42.6 [range, 17-69] years), 44 underwent attempted closure of the perforation at the time of the procedure. Closure was successful in 42 of the 44 patients (95%).Two patients had persistent perforations, one of which was subsequently closed in a secondary procedure. Twenty-six of 51 patients with septal perforations completed preoperative and postoperative NOSE questionnaires. The mean (SD) preoperative and postoperative NOSE scores were 12.6 (4.2; range, 6-20) and 3.4 (3.8; range, 0-12), respectively (P < .001). A mean (SD) improvement of 9.0 (3.9) points in the NOSE score was observed from patients after closure of their septal perforation, and 10 patients reported no symptoms (NOSE score, 0).
Costal perichondrium is an effective interpositional graft to be used in conjunction with the bilateral mucoperichondrial flaps for closure of septal perforations. Costal perichondrium may be used to aid in closure rates of septal perforations.
鼻中隔穿孔的闭合仍是一项技术上具有挑战性的操作。
评估使用肋软骨膜作为植入移植物，通过双侧黏膜瓣来促进鼻中隔穿孔闭合的方法及其效果。
设计、地点和参与者：该病例系列纳入了2006年1月1日至2014年8月31日在单一机构连续就诊的所有51例鼻中隔穿孔患者。平均（标准差）随访时间为19（18）个月。穿孔不完全的患者未进行穿孔闭合，而是接受了鼻整形术以改善外形和功能。所有患者均接受了术后症状变化的评估。
带蒂黏膜软骨膜瓣，并在修复的瓣之间放置肋软骨膜。
鼻中隔穿孔闭合的成功率，以及使用经过验证的鼻阻塞症状评估（NOSE）问卷（范围为0 - 20；分数越高表明阻塞越严重）评估患者穿孔闭合成功后的临床影响。
51例患者（14例男性；37例女性；中位年龄42.6岁[范围17 - 69岁]）中，44例在手术时尝试闭合穿孔。44例患者中有42例（95%）闭合成功。2例患者穿孔持续存在，其中1例随后在二次手术中闭合。51例鼻中隔穿孔患者中有26例完成了术前和术后的NOSE问卷。术前和术后NOSE评分的平均（标准差）分别为12.6（4.2；范围6 - 20）和3.4（3.8；范围0 - 12）（P <.001）。鼻中隔穿孔闭合后，患者的NOSE评分平均（标准差）提高了9.0（3.9）分，10例患者报告无症状（NOSE评分为0）。
肋软骨膜是一种有效的植入移植物，可与双侧黏膜软骨膜瓣联合用于闭合鼻中隔穿孔。肋软骨膜可有助于提高鼻中隔穿孔的闭合率。
4级
