Fibrin glue prevents complications of septal surgery: findings in a series of 100 patients

Septal surgery is a common type of otolaryngology--head and neck surgery, and it is often performed in combination with other procedures. Complications of septal surgery include bleeding, hematoma, infection, abscess formation, and perforation. The most common methods of preventing these complications are the use of nasal packing, septal splints, and quilting sutures as a means of approximating the septal flaps. In this article, we describe our study of an alternate method: fibrin glue. We used fibrin glue as the sole method of approximating flaps on 100 consecutive septal surgery patients. Our results indicate that the use of fibrin glue is effective, rapid, comfortable, and inexpensive.     

Efficacy of TnR Nasal Mesh for prevention of septal perforation during septoplasty

ObjectiveSeptoplasty has been reported as the most common cause of the septal perforation. The interposition of the graft materials between the flaps at the site of the tear may be helpful to decrease the likelihood of septal perforation. The purpose of this study was to investigate the efficacy of TnR Nasal Mesh on the prevention of septal perforation following septoplasty.MethodsAmong 46 patients had septal perforation after septoplasty, 35 patients were treated with TnR Nasal Mesh and 11 with autologous septal cartilage for bilateral mucosal tears at the corresponding area of the nasal septum. TnR Nasal Mesh or septal cartilage was placed between the injured mucoperichondrial flaps and confirmed in its original position at both sides under nasal endoscope. Objective endoscopic examination for septal mucosa status was evaluated between the patients who were treated with TnR Nasal Mesh or septal cartilage.ResultsTwenty patients (57.1%) showed complete bilateral mucosa healing and nine (25.7%) had unilateral healing after TnR Nasal Mesh insertion. However, complete bilateral and unilateral mucosa healing was observed in 4 (36.4%) and 1 patients (9.1%) treated with septal cartilage, respectively. Complete healing rate for septal perforation was significantly higher in TnR Nasal Mesh than in septal cartilage insertion (p=0.022). None of the patients showed complications or adverse reactions after TnR Nasal Mesh or septal cartilage treatment.ConclusionTnR Nasal Mesh insertion after bilateral septal mucosal tear during septoplasty reduces permanent septal perforation without an apparent adverse effect. Therefore, TnR Nasal Mesh may be a safe and effective graft material for the prevention of septal perforation following septoplasty.     

Effects of fibrin glue on nasal septal tissues

OBJECTIVES: To investigate the changes in adult rabbit nasal septal tissues after application of fibrin glue during septoplasty. STUDY DESIGN: Preclinical animal study. METHODS: Nineteen adult albino Vienna rabbits were included in the study. Rabbits were randomly divided into study (n = 14) and control groups (n = 5). The study group was subsequently divided into two subgroups with seven rabbits in each group to investigate short- and long-term effects of fibrin glue. After raising the mucoperichondrial flap on one side of the septum, fibrin glue was used to fix the mucoperichondrial flap over the septal cartilage. Rabbits were killed 3 weeks and 6 weeks after septoplasty. Samples from the excised nasal septa underwent routine tissue procedure for histopathologic investigation. RESULTS: Both short-term and long-term results were compared with the control group and with each other. There was a significant difference regarding mucosal inflammation and cartilaginous damage between groups. A significant difference was found between groups in terms of loss of cilia, loss of goblet cells, the presence and degree of fibrosis. Loss of cartilage was significantly different between groups. In comparing the thickness of the mucosa, thickness of the perichondrium, and thickness of cartilage, there were significant differences between groups. CONCLUSION: Our results demonstrate that fibrin glue causes distinctive inflammation, creates mucosal damage, increases mucosal thickness, decreases perichondrial thickness and cartilaginous thickness, and causes segmental cartilage loss in rabbits. Further comparative clinical investigations are required to assess the clinical efficacy of fibrin glue in nasal septal surgery in humans.     

异体脱细胞真皮基质黏膜组织补片修补鼻中隔穿孔

目的探讨修补直径大于1.0 cm的鼻中隔穿孔的最佳手术入路及修补材料。方法鼻内镜下联合唇龈沟入路应用双层瓣膜,即左侧为鼻中隔鼻底及下鼻道黏软骨膜/骨膜,右侧为异体脱细胞真皮基质黏膜组织补片(acellular dermal matrix,ADM),应用医用耳脑胶(EC胶)粘合修补鼻中隔穿孔。结果修补36例,成功率达100%,分别随访6个月～2年均无再穿孔。结论本手术中瓣膜面积大、根蒂宽、血供丰富,ADM无排斥反应,具有良好的生物相容性,EC胶粘合双层瓣膜成活率高。术式视野清晰,取材方便易行,缩短手术时间,减少供区创伤,是修补鼻中隔穿孔的最佳手术方案。     

Repair of nasal septal perforations using auricular conchal cartilage graft in children: report on three cases and literature review

OBJECTIVES: Repair of nasal septal perforation is a challenging procedure. Numerous methods have been described to close nasoseptal perforations with varying degrees of success. The lack of a consensus on nasoseptal perforation repair reflects the shortcomings of each method. There has been a paucity of literature on nasoseptal repair in the paediatric age group. We report our experience of repair of nasal septal perforation secondary to button battery injury using auricular conchal cartilage in the paediatric population. METHODS: Retrospective review of case notes and close regular follow-up of the patients since their first presentations with button batteries as foreign bodies in the nose. RESULTS: Three out of the three children who underwent repair of the nasal septum achieved successful closure of the nasal septum. One child with a large septal perforation required three procedures to achieve closure of the perforation. CONCLUSIONS: Repair of nasal septal perforations is a challenging procedure especially in children. Good results can be achieved with auricular conchal cartilage graft.     

Closure of septal perforations by means of ‘external rhinoplasty’

Objective. Evaluation of the ‘external rhinoplasty’ approach as a technique in the closure of septal perforations. Materials and methods. Ten patients with a septal perforation were studied. The average largest diameter ( sd ) was 1.48 cm 2 (0.39), as measured by lateral radiography after spreading the margins of the perforation with radiographic contrast fluid. Submucosal tunnels were made using a midcolumellar incision that was lengthened with marginal incisions, and the perforation was filled with aural cartilage. The extramucosalseparation of the upper lateral cartilages from the nasal septum allows the creation of a considerable mucosal flap in the nasal vault. By means of this transposition flap, together with a posterior based flap, all perforations could be covered. Results. Closure of nine septal perforations was successfully accomplished. Although it became smaller, one perforation persisted. Conclusion. The ‘external rhinoplasty’ approach provides a superior operative field. This visualization allows the formation of larger flaps. These advantages are translated into a greater success rate.     

鼻内镜下鼻中隔穿孔修补术

目的探讨经鼻内镜下鼻中隔穿孔修补术影响手术成功率的相关因素。方法23例外伤或手术后鼻中隔穿孔患者采用经鼻内镜下穿孔修补术，术中分别采用筛骨垂直板或颞肌筋膜直接封闭穿孔、翻转黏膜瓣及赝复物夹衬并转移黏膜瓣封闭、下鼻甲带蒂黏膜瓣修补等方法进行修复，并采用硅胶板或塑料膜的保湿物垫衬保护为特点的填塞方式。结果直接封闭7例，翻转封闭5例，转移封闭10例，鼻甲封闭1例。随访4周至7个月，23例鼻中隔穿孔手术修补成功19例（82、6％），4例未成功的病例分别为术后3周黏膜瓣脱落1例、术前存在2个穿孔仅将大穿孔修补成功1例、术后筋膜干燥导致再穿孔1例及转移黏膜瓣太小，穿孔未完全修补成功1例。结论鼻内镜手术是目前修补鼻中隔穿孔的最佳选择之一。     

Sublabial mucosal flap: Repair of septal perforations

The majority of perforations of the nasal septum, regardless of etiology, create little more than an annoyance to the patient. Perf orations commonly may be totally asymptomatic, discovered only on careful nasal examination. It is reasonable to assume, therefore, that only those septal defects creating important symptoms are deserving of repair and correction. Heavy crusting, recalcitrant bleeding and impending or actual loss of dorsal support are justifications for perforation closure. Textbooks and journals abound with suggested varieties of techniques of repair, testifying to the non-effectiveness of any one suitable approach. Local mucosal flaps, turbinate flaps, pedicle skin flaps, and free grafts of skin, dermis, perichondrium, cartilage, and fascia have all been employed with variable results. An inadequate blood supply and unfavorable scarred host bed commonly lead to failure of the above reconstruction methods. In the past five years a horizontal mucosal flap derived from the under-surface of the upper lip has proved reliable and expedient in septal perforation re-epithelialization and closure. The reconstructive procedure is not technically difficult and leads to minimal patient discomfort.     

Management of nasal septal abscess in childhood: our experience

A nasal septal abscess is usually the result of an infected hematoma of the septum. A secondary septal abscess may be the result of infections extending from any of the neighbouring tissues. The necrosis of septal cartilage may lead to nasal deformities and severe impairment of nasal patency and growth. OBJECTIVES: Assess if the drainage of the abscess and the immediate reconstruction of the destroyed nasal septum in the acute phase is the best treatment to prevent short- and long-term effect on nasal and midface growth. METHODS: Three pediatric patients treated with drainage and immediate implantation of homologous bank cartilage prior to 1990 and four treated with mosaic plastic using small pieces of residual septal cartilage assembled with fibrin glue. RESULT: No complication were observed in the follow-up and any deformities in the long-term controls. CONCLUSIONS: The drainage and immediate reconstruction of the nasal septum are the golden standard in the treatment of the septum infected haematoma.     

The histology of autologous auricular cartilage implanted into the nasal septum

This study attempts to evaluate the use of auricular cartilage for the treatment of nasal septal defects. A defect was made in the nasal septal cartilage in five rabbits and auricular cartilage grafted into the defect. The cartilage was microscopically examined 4 weeks later. The implanted cartilage was completely covered by ciliated columnar epithelium with minimal scar formation. Proliferation of the implanted cartilage and scattered ossification were observed. Seventeen patients with a nasal septal defect were treated by auricular cartilage implantation from April 1987 to through June 1992. Fiften patients (88%) had relief of symptoms and showed complete closure of the defect with a follow-up period of 2 years. The results of this study suggest that auricular cartilage may be of value in the repair of a nasal septal defect.     

Nasal Septal Perforation closure with bacterial cellulose in rabbits

Alloplastic materials can be used together with tissue and structure to close nasal septal perforation.Aimto test cellulose use in the closure of septal perforation in rabbits and to compare fibrosis, inflammation, vascular congestion and graft integrity.Materials and MethodsFifteen rabbits. The rabbits were divided into two groups: Control: Five rabbits and Bionext® and fibrin glue Tissucol®: Ten rabbits. Septal perforations were done in all of them. In the Bionext® group the closure was performed with the placement of cellulose.ResultsTwo rabbits died in the first week. Cellulose group: 2 closures without the cellulose in between the septum membrane and in 4 cases the graft stood in the middle of the perforation locked in place by the edges. No closure in the control group.ConclusionThere was no closure of the perforation of the nasal septum with the graft between the septum membranes. There was no statistically significant difference concerning acute inflammation, vascular congestion and fibrosis between the 2 groups. In cases in which the graft remained in place, there was no change in its integrity. It may be used as a substructure for reepithelization of the perforation edges.     

A new classification for septal perforation and effects of treatment methods on quality of life

IntroductionSeptal perforation is a condition characterized by loss of cartilage and/or bony structures along with the mucoperichondrium and mucoperiosteum lining them. The etiology includes a history of nasal surgery or trauma, nose picking, bilateral septal cauterization, overuse of nasal sprays, cocaine abuse, vasculitis, and malignancies.ObjectiveComparison of quality of life in patients with septal perforation after conservative or surgical treatment, and a new approach for the determination of the diameter of the perforation from a different point of view.MethodsThe diameter of septal perforation, total vertical diameter of septum, and horizontal diameter of the perforation were measured in a total of 34 patients. Nineteen of the patients underwent surgical septal perforation repair, and 15 of them received septal button application. The patients were asked to complete the Glasgow Benefit Inventory quality of life questionnaire.ResultsThe septal perforation successfully healed in 18 of 19 patients who underwent surgical treatment. The quality of life scores were statistically significantly higher in the surgical treatment group when compared to the button group (p < 0.05).ConclusionThe septal perforation classification we propose would be beneficial for providing realistic dimensions, treatment methods, and surgical techniques.     

Transvestibular closure with an autologous bone graft as surgical repair of a nasoseptal defect due to Le Fort-I osteotomy

Defects of the nasal septum are a common complication after nasal surgery. Affected patients frequently suffer from bleeding, crusting and impaired nasal air flow. The surgical closure of septal defects remains a distinctive challenge. Though many different techniques have been described, the failure rate of this procedure remains high. In the case presented here, a large basal septum defect occurred after a prosthetic Le Fort-I osteotomy. The attempt to cover the distance between the bony nasal floor and the nasal septum with pedicled mucosal flaps failed due to extensive scar formation of the nasal mucosa. Therefore a nasal floor elevation by insertion of an autologous bone graft from the iliac crest was conducted. The bone graft was connected with the hard palate via two titanium screws. Other than with an autologous cartilage graft, no major resorption of the bone graft is to be expected. This indirect method for the closure of a basal nasal septum defect is new.     

Comparison of suture and nasal packing in rabbit noses

OBJECTIVES/HYPOTHESIS: The study aimed to detect the changes in adult rabbit nasal septal tissues after application of nasal pack or trans-septal suture as performed during septoplasty. STUDY DESIGN: Randomized double-blind animal study. METHODS: Thirty-three adult albino Vienna rabbits were assigned into the following groups: control, suture, and nasal pack. The mucoperichondrium at one side of the nasal septum was elevated and then put into place again over the cartilage and fixed with either a nasal pack or an absorbable trans-septal suture. The nasal packs were removed 48 hours after insertion. Rabbits were killed 6 weeks after the procedure. The nasal septa were stained with hematoxylin and eosin and examined by means of light microscopy for mucosal changes (inflammation or damage) and for thicknesses of the mucosa, the perichondrium, and the cartilage. RESULTS: Both intranasal packs and sutures caused significant mucosal inflammation and damage when compared with the control group (chi test, P <.05). The mucosal thickness did not change, but the perichondrial thickness for both the nasal pack group and the suture group increased (Mann-Whitney U test, P <.05). Also, the septal cartilage thickness was not significantly different between the suture and the nasal pack groups, but the suture group had a thinner septal cartilage than the control group (Mann-Whitney U test, P <.05). CONCLUSION: The septal suture is an efficient and useful method for clinching the septal flaps over the septal cartilage. In addition, it has nearly the same effects as nasal packs on the histological appearance of the nasal septum and does not cause discomfort for the patient. The septal suture can be a preferred alternative to intranasal packing.     

鼻内镜下同种异体鼻中隔软骨移植术治疗鼻中隔穿孔

目的探讨鼻内镜下同种异体鼻中隔软骨移植术在鼻中隔穿孔修补中的疗效。方法收集2003—2011年采用夹层法治疗16例鼻中隔穿孔患者，在鼻内镜下行同种异体鼻中隔软骨移植术，术后定期鼻腔清洁和换药。结果15例穿孔I期愈合，1例Ⅱ期愈合，随访1—3年，无穿孔复发及不良反应，有效率100％。结论鼻内镜下同种异体鼻中隔软骨移植术在鼻中隔穿孔修补中疗效显著，具有较好的实用性。     

Nasal septal perforation repair using an inferior turbinate flap

RATIONALE: Nasal septal perforation repair presents a challenging problem to the otolaryngologist. Numerous surgical techniques for the repair of this nasal defect have been described. Although the literature describes great success using the advancement of local mucoperichondrial flaps, it is often difficult to reproduce these results, especially for the closure of larger defects. OBJECTIVE: To describe both the technique and the results of the senior author (P.J.B.), using a pedicled inferior turbinate flap for the closure of a nasal septal perforation in 20 patients. DESIGN: A retrospective case series of 20 consecutive adult patients treated from 2000 to 2005 inclusive. METHODS: A retrospective chart review was conducted of the 20 patients treated at the local tertiary care centre over the 5-year period. RESULTS: In 20 consecutive patients who were operated on by the senior author, the minimum perforation size was 1x1 cm and the average area of the perforation was 2.4 cm2. Overall, 80% of the perforations treated in this series were completely closed. CONCLUSION: The pedicled inferior turbinate flap is a valuable technique for the closure of a nasal septal perforation.     

Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft

The surgical closure of a nasal septal perforation is recognized as being particularly challenging. A series of 11 consecutive patients who underwent closure of a septal perforation using a mucosal flap/composite conchal cartilage graft technique are reviewed, and the surgical technique described. The size of the perforation repaired varied, with eight cases being 2 cm or more in diameter. There was no significant graft donor site morbidity and complete perforation closure was achieved in eight cases after a mean observation time of 19.8 months. These results suggest that this is a suitable technique for closing nasal septal perforation.     

Transnasal endoscopic repair of congenital defects of the skull base in children.

OBJECTIVE: To examine imaging findings and methods of endoscopic treatment of congenital skull base defects in children. DESIGN: Retrospective study and case series. SETTING: Academic tertiary care center. PATIENTS: Four patients (aged 12 and 14 months and 8 and 13 years) were included from 1995 to 1997. Three presented with a nasal glioma, which was recurrent in 1 case. The fourth patient presented with bacterial meningitis due to a spontaneous cerebrospinal fluid leak. Computed tomography and magnetic resonance imaging were used to locate the defect of the skull base. INTERVENTION: Transnasal endoscopic resection of the glioma or the meningocele, with immediate repair of the skull base defects using free mucosal flaps and/or pediculized mucosal flaps and/or conchal cartilage together with fibrin glue and nasal packing during a 3-week period. RESULTS: None of the 4 patients has experienced recurrent cerebrospinal fluid leaks or postoperative meningitis. CONCLUSIONS: The transnasal endoscopic repair of congenital meningoceles is a reliable technique in select pediatric patients. Computed tomography and magnetic resonance imaging provide information that can be used to help the surgical procedure.     

The one-stage rhinoplasty septal perforation repair

A combined septal perforation repair and rhinoplasty was performed in 20 patients (12 males, eight females; age range 16-36, mean age 29.6) presenting with septal perforations (size 1-4 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. The perforation was totally closed in 18 cases (90 per cent) with complete resolution of the pre-operative symptoms occurring in 16 (80 per cent). Cosmetically, 19 cases (95 per cent) were very satisfied with their aesthetic result. The exposure provided by the external approach proved to be very helpful in the process of septal perforation repair. Our results show that septal perforation repair could safely be combined with rhinoplasty and that some of the rhinoplasty manoeuvres used could even facilitate the process of septal perforation repair.