Effect of Temporal Fascia and Pedicle Inferior Turbinate Mucosal Flap on Repair of Large Nasal Septal Perforation via Endoscopic Surgery

Xu, Ming; He, Yong; Bai, Xueshan

doi:10.1159/000453269

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…21 Xu et al used temporalis fascia reported 100% success rate. 22 In the present study, the clinical follow-up showed that the perforations were successfully closed in 19 of 21 patients (90%) treated with bilateral advancement flaps and anterior maxillary sinus wall as interpositional graft. Although the number of patients and the follow-up periods were limited, the data show that anterior maxillary sinus wall is well tolerated as interpositional graft.…”

Section: Discussionsupporting

confidence: 53%

Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft

Hwang

Han

Kang

et al. 2021

Am J Rhinol�Allergy

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Background Various graft materials have been used to repair nasoseptal perforation, but there is no standardized treatment method. The anterior maxillary sinus wall is flattened in appearance and can be easily obtained in a sufficient amount for a large-sized nasoseptal perforation. Objectives The aim of this study is to determine whether the anterior maxillary sinus wall is suitable as an interpositional graft in the surgical repair of septal or nasoseptal perforation. Methods This is a retrospective review of 21 patients who underwent repair of nasoseptal perforation using anterior maxillary sinus wall as an interpositional graft. The etiology, pre- and post-operative NOSE and GBI score, and perforation size were reviewed. The surgical outcome was considered successful if total closure was achieved after postoperative follow-up. Results 19 of the 21 perforations were successfully repaired with anterior maxillary sinus wall. Failure of the repair was found in 2 patients. Causal etiology of perforation was previous septoplasty in 10 patients, and electrocautery in 1 case, but not identified in 10 cases. The largest size was 2.7 × 2.2 cm. The most common symptoms were epistaxis, crusting, and nasal obstruction. Closure of septal perforation resulted in improved subjective symptoms and quality of life which were evaluated with NOSE and GBI score. Conclusion Anterior maxillary sinus wall as interpositional graft between mucoperichondrial flaps can be used to reliably repair nasoseptal perforations.

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Section: Discussionsupporting

confidence: 53%

Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft

Hwang

Han

Kang

et al. 2021

Am J Rhinol�Allergy

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“…On the other hand, vascularized flaps, for example, pedicled nasal septal mucosal flaps and inferior nasal concha flaps, 19,24,29,30 and axial pattern flaps in other fields, 31 are known to heal well due to the stable blood supply to the flaps 7,32 . Reconstruction with vascularized flaps has superior treatment outcomes to nonvascularized grafts in terms of closure rates for large mucosal defects and the inhibition of ossification in areas of bone exposured 8,17,24 .…”

Section: Discussionmentioning

confidence: 99%

“…28 A study on a rabbit reconstruction model, using a nonvascularized graft for the skull base defect, reported that the respiratory epithelium, including ciliary cells, in the graft used for reconstruction completely disappeared 48 hours after reconstruction, and the epithelium at the reconstruction site had been replaced with squamous epithelium 3 weeks after reconstruction. 28 On the other hand, vascularized flaps, for example, pedicled nasal septal mucosal flaps and inferior nasal concha flaps, 19,24,29,30 and axial pattern flaps in other fields, 31 are known to heal well due to the stable blood supply to the flaps. 7,32 Reconstruction with vascularized flaps has superior treatment outcomes to nonvascularized grafts in terms of closure rates for large mucosal defects and the inhibition of ossification in areas of bone exposured.…”

Section: Discussionmentioning

confidence: 99%

Pathological Features of Free Graft and Pedicled Flap in the Nasal Cavity: An Animal Study

et al. 2020

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Objectives/Hypothesis Recent developments in reconstructive techniques for mucosal defects using mucoperiosteal materials have enabled rapid recovery of physiological function after endoscopic sinus surgery. Clinical trials have described the advantages, disadvantages, and different outcomes of free graft and pedicled flap, which, respectively, sacrifice or preserve blood flow. However, histological changes, that affect the postoperative outcomes after reconstruction, remain unclear. We created an animal model for the reconstruction of mucosal defects using free grafts and pedicled flaps, and evaluated them histologically. Study Design Animal study. Methods We created mucosal defects in the left nasal septum of 20 rabbits and performed reconstruction with free grafts and pedicled flaps. The distribution of ciliary and goblet cells at the reconstruction site was evaluated after 7 and 28 days using hematoxylin and eosin–stained sections to calculate the Ciliary Cell Index and Goblet Cell Index. The severity of inflammation was assessed using the Cartilage Inflammatory Cell Score. Results Crusting and changes in the mucosal morphology at the reconstruction site occurred only in the free graft group. In addition, the pedicled flap group had significantly greater preservation of ciliary and goblet cells and less inflammatory cell infiltration into the septal cartilage (P < .05) than the free graft group. Conclusions After reconstruction procedures for mucosal defects, histopathological differences were observed between the free graft and pedicled flap. Reconstruction with pedicled flaps had advantages including preservation of healthy mucosal epithelium and suppression of inflammation on the reconstruction site. This indicated that reconstruction with pedicled flaps might have advantages over that with free grafts. Level of Evidence NA Laryngoscope, 131:E428–E433, 2021

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“…Between challenging surgical conditions and hostile healing environments, operative results have been fraught with variable success rates ranging from 30% to 100%. 4 Numerous techniques have been designed to repair nasal septal perforation—bilateral mucoperichondrial flap repair with interposition graft, 5 staged inferior turbinate flap, 6 acelluar dermis interposition graft, 7 auricular cartilage interposition, 8 facial artery myomucosal (FAMM) flap, 9 and interposition grafting with synthetic 4,10,11 and autologous grafts. 12 In addition to operative technique, other contributing factors to successful closure and symptom resolution include the etiology of the septal perforation and the diameter, with perforations greater than 20 mm displaying higher failure rates.…”

Section: Introductionmentioning

confidence: 99%

Temporoparietal Fascia Graft and Polydioxanone Plate Repair of Nasal Septal Perforation

Meyer

Abtahi

Owen

2023

Ann Otol Rhinol Laryngol

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Background: Surgical repair of septal perforations has been historically cumbersome. Recently described techniques utilizing interposition grafting with polydioxanone (PDS) plates wrapped in a temporoparietal fascia (TPF) graft have reported successful closure in 90% to 100% of cases. Our objective is to expand the investigation into the use of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for nasal septal perforation repair. Methods: Retrospective review of the medical record was performed for all septal perforation repairs using the TPF-PDS plate interposition graft technique from August 1, 2017 to March 1, 2021 at the University of Iowa. Minimum post-operative follow-up was 1 month. Results: Our series included 31 patients with symptomatic nasal septal perforations. Thirteen patients underwent open while 18 patients underwent endonasal graft placement. The mean perforation size was 1.49 cm2. The mean post-operative follow-up was 11.5 months. Conclusions: Repair of symptomatic nasal septal perforations using an interposition graft of polydioxanone plate wrapped in temporoparietal fascia demonstrated an overall success rate of 90%.

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Effect of Temporal Fascia and Pedicle Inferior Turbinate Mucosal Flap on Repair of Large Nasal Septal Perforation via Endoscopic Surgery

Cited by 6 publications

References 20 publications

Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft

Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft

Pathological Features of Free Graft and Pedicled Flap in the Nasal Cavity: An Animal Study

Temporoparietal Fascia Graft and Polydioxanone Plate Repair of Nasal Septal Perforation

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