Epprecht Lorenz, Schlegel Christoph, Holzmann David, Soyka Michael, Kaufmann Thomas
Am J Rhinol Allergy. 2017 May 1;31(3):190-195. doi: 10.2500/ajra.2017.31.4431.
Septal perforation closure is still often invasive and complex, with relatively low closure rates.
We aimed to provide the first results of a case series of 20 patients with nasal septal perforations who underwent septal perforation repair by both an open and a minimally invasive technique by using a graft that consisted of temporoparietal fascia and a polydioxanone (PDS) plate without mucosal flaps. Between 2014 and 2016, we tested, for the first time, the feasibility of the insertion of this graft via a hemitransfixion incision at our institution. The rationale for the closed approach was to avoid any visible nasal scars. We reported our results of both approaches.
The septal perforations were closed by insertion of a graft, which consisted of a 0.25-mm PDS flexible plate enveloped by temporoparietal fascia, into the perforation. The insertion of the graft was performed either via a columellar incision (open approach) or via a cosmetically advantageous hemitransfixion incision (closed approach) in an underlay technique. No attempts were made to close the perforation by mucosal flap rotation and/or advancement. Protective silastic sheeting to both sides of the perforation provided fixation to the graft while natural mucosal healing occurred over the perforation in the course of 3 to 8 weeks.
Eighteen of 20 perforations were closed by mucosa at the last follow-up. The mean follow-up was 8.7 months. Thirteen patients had surgery via the closed approach.
We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.
鼻中隔穿孔闭合术通常仍具有侵入性且操作复杂，闭合率相对较低。
我们旨在提供20例鼻中隔穿孔患者病例系列的首批结果，这些患者采用颞顶筋膜和聚二氧六环酮（PDS）板组成的移植物，通过开放和微创技术进行鼻中隔穿孔修复，未使用黏膜瓣。2014年至2016年期间，我们首次在本机构测试了经半鼻中隔切开术切口插入该移植物的可行性。采用闭合入路的基本原理是避免出现任何可见的鼻部瘢痕。我们报告了两种入路的结果。
通过将由0.25毫米PDS柔性板包裹在颞顶筋膜内组成的移植物插入穿孔来闭合鼻中隔穿孔。移植物的插入通过小柱切口（开放入路）或通过美容效果较好的半鼻中隔切开术切口（闭合入路）采用衬里技术进行。未尝试通过黏膜瓣旋转和/或推进来闭合穿孔。在穿孔两侧放置保护性硅橡胶片，为移植物提供固定，同时在3至8周的时间里，穿孔处实现自然黏膜愈合。
在最后一次随访时，20个穿孔中有18个被黏膜封闭。平均随访时间为8.7个月。13例患者通过闭合入路进行手术。
我们首次表明，经半鼻中隔切开术切口插入由包裹在颞顶筋膜内的PDS柔性板组成的移植物是可行的，并且在大多数患者中可实现鼻中隔穿孔的完全黏膜闭合。通过进行半鼻中隔切开术切口，我们避免了任何可见的鼻部瘢痕。
