Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City.
JAMA Facial Plast Surg. 2019 Jul 1;21(4):319-326. doi: 10.1001/jamafacial.2019.0020.
Numerous techniques are used for septal perforation repair, yet success rates remain variable. Few studies have evaluated the effectiveness of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair.
To investigate and describe the use of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair and the expansion of this technique to patients with more challenging comorbidities, including granulomatosis with polyangiitis.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical record review was performed of patients who underwent septal perforation repair using interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft from January 1, 2015, to July 1, 2018, at Vanderbilt University Medical Center and from January 1, 2017, to July 1, 2018, at the University of Iowa.
All patients underwent septal perforation repair with interposition grafts of polydioxanone plates and a temporoparietal fascia graft.
Assessing closure of septal perforation was the primary outcome. Secondary outcomes were resolution of presenting symptoms of septal perforation, area of perforation, length of postoperative stent and silastic sheeting placement, postoperative complications and resolution, and duration of follow-up. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed.
A total of 17 patients (12 women and 5 men; mean [SD] age, 45 [15] years) were included. The causes of perforations were iatrogenic (9 [53%]), rheumatologic (2 [12%]), and unknown or idiopathic (6 [35%]). Patients most commonly presented with nasal crusting (12 [71%]), whistling (9 [53%]), nasal obstruction (9 [53%]), and epistaxis (5 [29%]). Mean (SD) perforation size was 0.99 (1.04) cm2. Mean (SD) postoperative follow-up was 6.1 (4.1) months. A total of 15 patients (88%) had complete resolution of presenting symptoms at last follow-up. All perforations were closed with overlying mucosa at the most recent follow-up examination. Nine of 17 patients completed both preoperative and postoperative NOSE. There was a significant difference between the mean (SD) preoperative and postoperative NOSE scores (62.78 [27.74] vs 17.78 [15.83]; P = .004).
Repair of symptomatic nasal septal perforations using a temporoparietal fascia graft combined with a polydioxanone plate was associated with positive outcomes. Repair of septal perforations caused by rheumatologic disease, including granulomatosis with polyangiitis, can be considered for repair using this technique. Resolution of symptoms appeared to be clinically more meaningful in evaluation of septal perforation repair than rate of perforation closure, and the NOSE scale has the potential to serve as an objective corroboration to patient-reported postoperative outcomes.
有许多技术用于修复鼻中隔穿孔，但成功率仍然各不相同。很少有研究评估过聚二氧杂环酮板间置移植物联合颞顶筋膜移植物修复鼻中隔穿孔的效果。
研究并描述聚二氧杂环酮板间置移植物联合颞顶筋膜移植物修复鼻中隔穿孔的应用，并将该技术扩展到患有更具挑战性合并症的患者，包括肉芽肿性多血管炎。
设计、地点和参与者：对 2015 年 1 月 1 日至 2018 年 7 月 1 日期间在范德比尔特大学医学中心和 2017 年 1 月 1 日至 2018 年 7 月 1 日期间在爱荷华大学接受聚二氧杂环酮板间置移植物联合颞顶筋膜移植物修复鼻中隔穿孔的患者进行回顾性病历审查。
所有患者均接受聚二氧杂环酮板和颞顶筋膜间置移植物修复鼻中隔穿孔。
评估鼻中隔穿孔的闭合情况是主要结局。次要结局是鼻中隔穿孔的现有症状是否得到缓解、穿孔面积、术后支架和硅酮片放置时间、术后并发症及其解决情况以及随访时间。评估术前和术后鼻阻塞症状评估（NOSE）评分。
共纳入 17 例患者（12 例女性和 5 例男性；平均[标准差]年龄 45[15]岁）。穿孔的原因是医源性（9 例[53%]）、风湿性（2 例[12%]）和不明原因或特发性（6 例[35%]）。患者最常见的症状是鼻腔结痂（12 例[71%]）、哨声（9 例[53%]）、鼻塞（9 例[53%]）和鼻出血（5 例[29%]）。平均（标准差）穿孔大小为 0.99（1.04）cm2。平均（标准差）术后随访时间为 6.1（4.1）个月。在最后一次随访时，15 例（88%）患者的现有症状均完全缓解。所有穿孔在最近的随访检查中均被覆盖的黏膜封闭。17 例患者中有 9 例完成了术前和术后的 NOSE。术前（62.78[27.74]）和术后（17.78[15.83]）NOSE 评分的平均值差异有统计学意义（P = .004）。
使用颞顶筋膜移植物联合聚二氧杂环酮板修复有症状的鼻中隔穿孔可获得良好的效果。对于由风湿性疾病引起的鼻中隔穿孔，包括肉芽肿性多血管炎，可以考虑使用这种技术进行修复。与穿孔闭合率相比，症状的缓解在评估鼻中隔穿孔修复方面似乎更具临床意义，NOSE 量表有可能成为患者报告的术后结果的客观佐证。
4 级。
