Romo T, Jablonski R D, Shapiro A L, McCormick S A
Department of Otolaryngology-Head and Neck Surgery, New York Medical College, Valhalla.
Arch Otolaryngol Head Neck Surg. 1995 Mar;121(3):327-31. doi: 10.1001/archotol.1995.01890030057009.
Reperforation rates of large, surgically closed nasoseptal perforations remain unacceptably high (30% to 70%). With the advent of newer surgical techniques, including external decortication rhinoplasty and midface degloving, excellent exposure of the intranasal anatomy is afforded. The limiting factor of these approaches is the deficiency of local intranasal mucosal lining, which is used to close large septal perforations. The paucity of nasal mucosal lining results in excessive tension on the perforation closure suture line that leads to distal flap ischemia, anastomosis breakdown and, ultimately, reperforation of the septum. Alternatively, using intraoral mucosal flaps of sufficient length and width to close large perforations results in significant and unacceptable donor-site morbidity. We present our technique of harvesting additional local endonasal mucosa using long-term soft-tissue expanders. Long-term nasal mucosal expansion was used in the closure of large septal perforations in five patients. Complications included one case of expander exposure and the morbidity of prefacial expander injections. Total closure of all five septal perforations was documented at the 1-year postsurgical visit. Histologic and electron-microscopic examinations of the expanded nasal floor mucosa are presented.
大型手术封闭的鼻中隔穿孔的再穿孔率仍然高得令人无法接受（30%至70%）。随着包括外剥脱性鼻成形术和中面部去套状术等更新的手术技术的出现，可以很好地暴露鼻腔内的解剖结构。这些方法的限制因素是用于封闭大型鼻中隔穿孔的鼻腔内局部黏膜衬里不足。鼻腔黏膜衬里的缺乏导致穿孔闭合缝合线上的张力过大，进而导致远端皮瓣缺血、吻合口破裂，并最终导致鼻中隔再穿孔。或者，使用足够长度和宽度的口腔黏膜瓣来封闭大型穿孔会导致严重且不可接受的供区并发症。我们介绍了使用长期软组织扩张器获取额外局部鼻内黏膜的技术。长期鼻腔黏膜扩张用于5例患者大型鼻中隔穿孔的封闭。并发症包括1例扩张器外露和面部扩张器注射的并发症。在术后1年的随访中记录了所有5例鼻中隔穿孔均完全闭合。本文还展示了对扩张后的鼻底黏膜进行的组织学和电子显微镜检查。
