medwireNews: Polyethylene implants are an effective and technically easy way to repair nasal septal perforations (SPs), a Canadian study shows.
Fourteen patients with SPs who presented between 2008 and 2011 participated in the study, with 13 (93%) patients undergoing successful repair with polyethylene implants.
Writing in JAMA Facial Plastic Surgery, lead author Paul Marck (University of Calgary, Alberta) and colleagues say that the technique "is associated with low patient morbidity because it does not require the harvesting of any tissue from other donor sites, such as the pericranium, temporalis fascia, or conchal bowl of the ear."
The surgery was carried out under general anesthetic, using the endonasal approach. The size of the SP was measured so that the implant could be trimmed appropriately, before being placed between bilateral mucoperichondrial flaps. The operations were carried out in a mean time of 28 minutes and patients were discharged the same day, with instructions on postoperative care.
Successful closure of the SP was defined as an intact polyethylene graft with complete remucosalization of at least one side of the graft at 1-year follow-up. In fact, 1 year after surgery the researchers found that 13 of the 14 patients had successful closure and bilateral mucosal coverage.
One patient's implant had extruded at 3-month follow-up; however, the researchers note, "that patient had not been compliant with postoperative care."
SPs can cause symptoms such as nasal crusting, discharge, and bleeding. To determine how effective the surgery was at symptom resolution, patients were asked to complete a questionnaire assessing preoperative and postoperative symptoms.
After 1 year, significant improvements were seen in the most common symptom of crusting, as well as in nasal discharge, with a trend for improvement observed in nose bleeds.
Marck and colleagues point out that "endonasal techniques have traditionally been considered more challenging because they do not offer the exposure provided by external approaches."
However, they suggest that it was appropriate for this surgery because the implant did not require complex maneuvers, and furthermore "the endonasal approach has the added benefit of being familiar to the general otolaryngologist."
"The application of the polyethylene interpositional graft with the endonasal technique resulted in successful closure rates comparable to those of other techniques," they conclude.
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