Edmonton, Alberta, and Toronto, Ontario, Canada.
From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta; and the Department of Otolaryngology-Head and Neck Surgery, Department of Surgical Oncology, University Health Network, University of Toronto.
Plast Reconstr Surg. 2018 Jun;141(6):1517-1524. doi: 10.1097/PRS.0000000000004410.
Nasal septal perforations pose a troubling source of morbidity for patients and a difficult problem for the otolaryngologist. Multiple surgical techniques have been tried, with inconsistent success. Prosthetic nasal buttons also have limitations, including patient intolerance and dissatisfaction. Acellular human dermal allograft (AlloDerm) has been described as an alternative material for septal perforation repair. The authors studied objective and subjective outcomes, including quantification of the patient's symptoms in septal perforation repair with AlloDerm.
The authors performed a prospective cohort study of 12 patients with 1- to 2-cm anterior septal perforations who were recruited from a tertiary care practice. Patients with admitted smoking or cocaine use in the previous 3 months or vascular or granulomatous diseases were excluded. Subjective scores on the Sino-nasal Outcome Test-22, along with objective nasal endoscopy and acoustic rhinometry measures, were collected at baseline and 2, 4, and 12 weeks postoperatively. Patients were followed for reperforation 9 to 20 months postoperatively. Data were normalized to baseline values and analyzed using analysis of variance and Bonferroni correction.
Successful closure of the septal perforation was obtained in 10 of 12 patients and confirmed with rigid nasal endoscopy. Nasal symptom scores (Sino-nasal Outcome Test-22 ) were significantly reduced to 52.8 percent (95 percent CI, 35.1 to 70.5 percent; p < 0.01) of baseline symptoms at 4 weeks postoperatively. At 12 weeks postoperatively, symptoms were measured at 26.6 percent (95 percent CI, 10.9 to 42.1 percent; p < 0.01) of baseline symptoms. Acoustic rhinometry confirmed perforation closure, demonstrating a reduction in cross-sectional nasal area from baseline of 55.1 percent (95 percent CI, 37.7 to 66.8 percent; p < 0.01).
This is the first study to use objective and subjective measurements to confirm success with acellular dermis allograft as an adjunct for septal perforation repair, demonstrating a statistically significant reduction in patient nasal symptoms following repair.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
鼻中隔穿孔给患者带来了令人困扰的发病率，也给耳鼻喉科医生带来了难题。已经尝试了多种手术技术，但成功率不一。假体鼻钮也有其局限性，包括患者不耐受和不满意。脱细胞异体真皮（AlloDerm）已被描述为修复鼻中隔穿孔的替代材料。作者研究了客观和主观结果，包括使用 AlloDerm 修复鼻中隔穿孔时量化患者的症状。
作者对 12 名患有 1-2cm 前鼻中隔穿孔的患者进行了前瞻性队列研究，这些患者是从三级护理机构招募的。排除了在过去 3 个月内有吸烟或可卡因使用史或血管或肉芽肿性疾病的患者。在基线和术后 2、4 和 12 周时收集 Sino-nasal Outcome Test-22 主观评分以及鼻内窥镜和鼻声反射测量值。术后 9-20 个月对患者进行穿孔再发随访。数据经基线值归一化，并采用方差分析和 Bonferroni 校正进行分析。
12 名患者中有 10 名成功闭合了鼻中隔穿孔，并通过刚性鼻内窥镜得到证实。术后 4 周时，鼻部症状评分（Sino-nasal Outcome Test-22）显著降低至基线症状的 52.8%（95%CI，35.1-70.5%；p<0.01）。术后 12 周时，症状测量值为基线症状的 26.6%（95%CI，10.9-42.1%；p<0.01）。鼻声反射证实穿孔闭合，横截面鼻面积从基线减少 55.1%（95%CI，37.7-66.8%；p<0.01）。
这是第一项使用客观和主观测量来确认脱细胞真皮移植物作为鼻中隔穿孔修复辅助材料成功的研究，证明修复后患者鼻部症状有统计学意义的显著降低。
临床问题/证据水平：治疗性，IV。
