Hanci Deniz, Üstün Onur, Yilmazer Ayça Başkadem, Göker Ayşe Enise, Kumral Tolgar Lütfi, Uyar Yavuz
Department of Otorhinolaryngology, Okmeydani Training and Research Hospital.
Department of Otorhinolaryngology, Haseki Training and Research Hospital, Istanbul, Turkey.
J Craniofac Surg. 2020 Jul-Aug;31(5):1327-1329. doi: 10.1097/SCS.0000000000006320.
Repair of the septal perforation is a challenging procedure and there are many different surgical techniques. In this study, the authors present a novel method which the authors use costal cartilage and costal perichondrium sandwich graft as an interposition graft with bilateral opposing mucoperichondrial flaps.
Fourteen patients (5 females, 9 males) underwent septal perforation repair. All surgeries were performed through an open approach septoplasty technique. The edges of the perforation were incised to excise the mucosa with a thickness of 2 mm. Bilateral mucoperichondrial flaps were raised. Then costal cartilage and costal perichondrium were harvested from the rib. The cartilage was divided into a smaller piece which is 2 mm thick and 1 cm wider than perforation size. The prepared cartilage was wrapped with perichondrium to obtain a sandwich graft. This sandwich graft was placed between the mucoperichondrial flaps, corresponding to the perforation.
After 9 months of follow-up, 11 (78%) of the 14 perforations were completely closed. Failure of the repair was observed in 3 patients; 2 of the perforations were medium size and one perforation was large size. No complications occurred.
Using costal cartilage and costal perichondrium sandwich graft is a novel and useful technique especially in large septal perforations. Considering that septum surgery has an important role in the etiology of septum perforation, this method provides a good graft source for both perforation closure and simultaneous rhinoplasty surgery.
鼻中隔穿孔修复是一项具有挑战性的手术，存在多种不同的手术技术。在本研究中，作者介绍了一种新方法，即使用肋软骨和肋软骨膜三明治移植物作为插入移植物，并结合双侧相对的粘软骨膜瓣。
14例患者（5例女性，9例男性）接受了鼻中隔穿孔修复手术。所有手术均通过开放式鼻中隔成形术技术进行。切开穿孔边缘以切除厚度为2毫米的黏膜。掀起双侧粘软骨膜瓣。然后从肋骨获取肋软骨和肋软骨膜。将软骨切成厚度为2毫米、比穿孔尺寸宽1厘米的较小片。将制备好的软骨用软骨膜包裹以获得三明治移植物。将此三明治移植物置于对应穿孔的粘软骨膜瓣之间。
随访9个月后，14个穿孔中有11个（78%）完全闭合。3例患者修复失败；其中2个穿孔为中等大小，1个穿孔为大尺寸。未发生并发症。
使用肋软骨和肋软骨膜三明治移植物是一种新颖且有用的技术，尤其适用于大型鼻中隔穿孔。鉴于鼻中隔手术在鼻中隔穿孔病因中起重要作用，该方法为穿孔闭合和同期鼻整形手术提供了良好的移植物来源。
