鼻中隔穿孔手术治疗41例报告

目的探讨手术治疗鼻中隔穿孔的最佳径路和方法.方法鼻中隔穿孔41例中,经前鼻孔径路10例,经鼻翼切开径路16例(联合内镜1例),蝶形切开径路6例,鼻内镜下径路8例,唇下径路1例,手术均在局麻下进行,31例用复合瓣修补,用耳脑胶固定.结果经前鼻孔径路单层瓣膜修补10例中,4例再穿孔,采用鼻翼切开,鼻翼鼻小柱蝶形切开,鼻内镜下径路,复合瓣修补,耳脑胶固定治疗,均一期愈合.结论对不同的鼻中隔穿孔要用不同的手术径路,复合瓣修补,耳脑胶固定瓣膜等是目前修补鼻中隔穿孔的有效方法.     

带蒂鼻腔黏骨膜瓣联合鼻中隔减张皮瓣修补鼻中隔穿孔(附3例报告)

目的探讨鼻中隔穿孔修补术的方法。方法3例鼻中隔穿孔病人采用鼻内镜联合显微镜下,应用带蒂鼻腔黏骨膜瓣翻转联合鼻中隔减张皮瓣修补术,并用保湿物鼻腔填塞方式。结果随访1~2年,3例鼻中隔穿孔手术修补成功。结论鼻内镜联合显微镜下,应用带蒂鼻黏骨膜瓣翻转联合鼻中隔减张皮瓣修补术是修补鼻中隔穿孔行之有效的治疗方法。     

鼻内镜下鼻中隔带蒂黏膜瓣修复鼻中隔穿孔和脑脊液鼻漏

目的探讨鼻内镜下鼻中隔带蒂黏膜瓣用于修补鼻中隔穿孔和脑脊液鼻漏的疗效。方法2005年8月～2008年2月北京同仁医院鼻科共11例鼻中隔穿孔和8例脑脊液鼻漏患者。鼻中隔穿孔位于鼻中隔前部,穿孔大小0.8 cm～2.0 cm,在鼻内镜下采用邻近穿孔后上方的鼻中隔带蒂黏骨膜瓣(黏软骨膜瓣)向前下反转覆盖于鼻中隔穿孔黏膜缺损处,对侧采用穿孔前下方带蒂黏骨膜瓣(黏软骨膜瓣)和鼻底黏膜瓣或下鼻甲带蒂黏膜瓣覆盖修补穿孔。8例脑脊液鼻漏患者,2例漏出部位在嗅裂,5例漏出部位在筛顶,1例漏出部位位于嗅裂延续至后筛顶,面积大小为0.1 cm×0.8 cm～0.3 cm×0.8 cm。采用邻近的鼻中隔带蒂黏骨膜瓣反转覆盖于缺损处,必要时黏膜瓣中间夹层钩突或中鼻甲骨片,外覆邻近的鼻中隔带蒂黏膜瓣修补漏出部位。结果11例鼻中隔穿孔和8例脑脊液鼻漏均一次修补成功,随访3个月～3年,未见复发。鼻中隔黏膜转瓣后供区黏膜缺损区在2周后基本上皮化。结论鼻中隔带蒂黏骨膜瓣(黏软骨膜瓣)自身有血供,成活率高,获取容易,取材区域广泛,转蒂距离充足,是修补鼻中隔穿孔和嗅裂和筛顶脑脊液鼻漏的良好材料。     

鼻内镜下鼻腔带蒂黏骨膜瓣修复鼻中隔穿孔北大核心CSCD

鼻中隔穿孔是耳鼻咽喉科较为常见且治疗棘手的疾病之一，主要治疗方式是经鼻内镜下鼻中隔穿孔修补术。但如何选择用于修补的移植瓣膜，目前并无公认的标准，大多取决于外科医生的经验。本文通过文献回顾以及作者本人的经验体会，就鼻中隔穿孔的相关问题以及几种常见的鼻腔带蒂黏骨膜瓣的选择进行介绍，以期提高经鼻内镜下鼻中隔穿孔修补术的成功率。     

鼻内镜下带蒂鼻中隔黏骨膜瓣转位联合游离下鼻甲黏膜瓣修补鼻中隔穿孔

目的探讨鼻内镜下行带蒂鼻中隔黏骨膜瓣转位联合游离下鼻甲黏膜瓣修补鼻中隔穿孔的疗效及分析手术经验。方法 2006年2月~2013年12月我院收治的鼻中隔穿孔患者12例,在鼻内镜下鼻中隔穿孔一侧行带蒂鼻中隔黏骨膜转位贴补联合另一侧游离下鼻甲黏膜组织瓣贴补术,术后随访观察鼻中隔穿孔修补创面愈合情况及修补效果。结果 12例鼻中隔穿孔均一期修补成功,随访3个月以上未见再穿孔。结论鼻内窥镜下行带蒂鼻中隔黏骨膜瓣转位联合游离下鼻甲黏膜瓣修补鼻中隔是一种操作方便、安全、可靠的方法。     

带蒂鼻前庭骨膜瓣显微手术修补鼻中隔穿孔

带蒂鼻前庭骨膜瓣显微手术修补鼻中隔穿孔董人禾，高智蔚临床上修补鼻中隔穿孔的方法很多，但效果不尽理想。１９７８年至１９９３年，我们采用带蒂鼻前庭骨膜瓣显微手术修补鼻中隔穿孔，取得了较好的效果。兹介绍如下。１资料与方法１．１临床资料本组鼻中隔穿孔患者２１...     

鼻内镜下上颌窦前壁带蒂肌骨膜瓣修补鼻中隔穿孔

鼻中隔穿孔修补一直是耳鼻喉科医生认为比较棘手的问题之一。目前对有症状的鼻中隔穿孔仍以手术修补为主。2001年4月-2005年8月我科采用鼻内镜下上颌窦前壁带蒂肌骨膜瓣，经鼻底隧道修补鼻中隔穿孔，取得较好疗效，现介绍如下。     

鼻中隔大穿孔修补术

作者们综合各型鼻中隔穿孔手术方法和原则,发展了本文介绍的鼻中隔穿孔修补术。鼻中隔修补取得成功的基本原则是;(1)保证皮瓣供血良好;(2)手术野暴露清楚,易于操作;(3)缝线应固定于间皮组织内,利于皮瓣存活;(4)用厚骨膜瓣修补比薄的软骨膜瓣为坚固。鼻中隔大穿孔修补方法:手术在全麻下进行,鼻内和口内唇龈沟处加用10%可卡因4ml表面麻醉和1%利多卡因加1∶100,000肾上腺素局部浸润麻醉。沿唇龈沟作切口,直至骨膜。用骨膜刮离子由内侧向外分离骨膜至梨状窝达犬齿窝。用拉钩拉开上唇和鼻粘膜,暴露梨状窝。用一垂直刀由唇下径路进入,沿中隔后缘作切口,     

带蒂鼻腔底黏骨膜瓣修补鼻中隔穿孔11例

目的:探讨采用以鼻腔底后端为基蒂的黏骨膜瓣旋转修补鼻中隔穿孔的疗效。方法:用类似鼻中隔黏膜下矫正术的方法分离鼻中隔穿孔周边的黏软骨膜及骨膜,并向下连接左鼻腔底后端为基蒂的黏骨膜瓣,将黏骨膜瓣向后上旋转,覆盖并缝合于穿孔周边的黏软骨膜及骨膜袋内。结果:11例鼻中隔穿孔修补患者均一期愈合,修补成功。结论:采用自体带蒂鼻腔底黏骨膜瓣修补鼻中隔穿孔,取材方便;无排斥反应;带蒂黏骨膜瓣血供良好,成活率高;鼻腔底部黏骨膜面积宽而长,修补较大穿孔时,可根据穿孔的大小和形状,提供足够的移植材料。     

鼻内镜下鼻中隔软骨或筛骨修补鼻中隔穿孔

目的〓〖HTK〗探讨鼻内镜下应用鼻中隔软骨或筛骨修补鼻中隔穿孔的临床效果。〖HTW〗方法〓〖HTK〗22例鼻中隔穿孔中鼻中隔矫正术所致12例,外伤性穿孔2例,化学物质腐蚀性穿孔2例,激光、微波烧灼性穿孔3例,原因不明3例。鼻内镜下应用鼻中隔软骨或筛骨修补鼻中隔穿孔,形成骨性支架,术后用湿润烧烫伤膏MEBO涂抹创面,促进周边黏膜向穿孔处生长。〖HTW〗结果〓〖HTK〗患者均一次修复成功,穿孔处双侧骨质暴露区域被黏膜完全覆盖25～62d,随访2～3年无再次穿孔,均无手术并发症。 〖HTW〗结论〓〖HTK〗鼻内镜下应用鼻中隔软骨或筛骨修补鼻中隔穿孔安全、简便、有效。     

Usefulness of autologous cartilage and fibrin glue for the prevention of septal perforation during septal surgery: a preliminary report

OBJECTIVES: Septal surgery is one of the most common causes of nasal septal perforation. In cases in which a septal mucosal defect at the corresponding area has occurred, autologous cartilage is usually inserted between the injured mucosal flaps. In addition, we applied fibrin glue to the margins of injured mucosal surface to fix the inserted cartilage and to promote mucosal regeneration. The aim of this study was to evaluate the efficacy of this method in the prevention of nasal septal perforation. STUDY DESIGN: Retrospective analysis of medical records. METHODS: A total of 463 septal surgeries were performed between March 2003 and August 2005. Septal mucosal defect at the corresponding area occurred in 34 patients. In group 1 (23 patients), septal or auricular cartilage was inserted between the injured mucosal flaps. In group 2 (11 patients), septal or auricular cartilage was inserted, and fibrin glue was applied on the mucosal margins of cartilage insertion site. We compared the perforation rate between the two groups. RESULTS: In group 1, nasal septal perforation occurred 8 of 23 (34.8%) patients, and in group 2, 1 of 11 (9.1%) patients experienced perforation. Although the occurrence rate of perforation was significantly lower in group 2, statistical significance between the two groups could not be established because of the small number of patients who experienced septal perforation. CONCLUSION: The application of fibrin glue at the bilaterally injured mucosal surface after cartilage insertion is thought to be very useful as a preventive measure of nasal septal perforation. We report these results as preliminary data for further study to determine the usefulness of fibrin glue in the prevention of nasal septal perforation.     

A new method of nasal dermoplasty (MW grafting method) in patients with large septal perforation

Nasal dermoplasty is effective in controlling epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). Skin graft take failure occurs mostly in cases of large septal perforation. The MW method was developed as a modification of nasal dermoplasty designed for patients with HHT having a large septal perforation. It seems to be a safe and effective approach and should be tried for recurrent bleeders with septal perforation.     

Cierre endoscópico de las perforaciones septales

Objective

The management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation.

Surgical considerations in the open rhinoplasty approach to closure of septal perforations

Repair of nasoseptal perforations is a difficult problem for the otolaryngologist. Recently, there has been an increased incidence among patients, particularly with the rise in cocaine abuse and trauma. The variety of proposed methods of repair points to the lack of a definitive solution for successful surgical treatment of nasoseptal perforations. Successful septal perforation repairs using an open rhinoplasty approach with bipedicled mucoperichondrial flaps and temporal fascia grafts were achieved in eight of nine patients in a series. Resident otolaryngologists in training were the primary surgeons in all nine patients. The open rhinoplasty approach affords better exposure to the septal perforation than does a closed technique, and it facilitates the elevation of mucoperichondrial flaps on all sides of the perforation. This method also allows the surgeon access to perform a limited concurrent rhinoplasty when indicated. The open rhinoplasty approach is ideally suited for teaching the technique of large septal perforation closure in surgical training programs. The surgical considerations in using this method are discussed.     

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.     

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.     

Bioactive glass and turbinate flaps in the repair of nasal septal perforations

Interpositional grafts between mucoperiosteal flaps are commonly used in the repair of septal perforations. We studied the use of bioactive glass (BAG) S53P4 as an interpositional graft and the use of turbinate flaps in 23 patients with septal perforations. Another 16 patients were treated with mucoperiosteal flaps only. The perforations were successfully closed in 38 of the 39 patients. One patient had a near-total septal perforation due to hypophysial surgery; it could not be closed. No extrusions of the BAG and no BAG-associated infections were seen; the average follow-up period was 28 months. BAG S53P4 seems to be a good interpositional graft in the repair of medium and large nasal septal perforations, and turbinate flaps are also reliable.     

Endoscopic Repairment of Septal Perforation with Using a Unilateral Nasal Mucosal Flap

Objectives

Nasal septal perforation is an anatomic defect of the cartilaginous and bone tissues of the nasal septum. Many approaches and techniques to repair nasal septal perforations have been reported on. The purpose of this paper is to report on our surgical technique and the results of the treatment for nasal septal perforations.

Methods

From May 2001 to March 2008, 14 patients (12 males and 2 females; mean age: 41.3 yr) were enrolled. The mean perforation size was 15 mm, and all the perforations were located at the cartilaginous portion. Our surgical technique is based on an endoscope-assisted endonasal approach, with dissection of unilateral advanced mucosal flaps with using a temporalis fascia graft. The follow-up periods ranged from 3 to 23 months (mean follow-up period: 8 months).

Results

Using our surgical technique on 14 patients, 12 cases (85.7%) of septal perforation were closed without complication. The remaining two patients (14.3%) had incomplete closures (about 2-3 mm) without any significant symptoms related to the remaining perforation.

Conclusion

Our technique is a viable procedure with a high success rate for achieving closure of nasal septal perforations. It has the advantages of shortening the operative time, no external incision and avoiding any other perforation during the operation. Therefore, we consider it to be a good alternative for repairing nasal septal perforations.     

Predictive factors for the outcome of nasal septal perforation repair

Objectives

The aim of this study was to determine the important predictive factors for successful repair of nasal septal perforation.

Materials and methods

In this study, we examined 35 symptomatic patients (27 males and 8 females, aged from 16 to 76 years) with a nasal septal perforation. In order to correlate pre- and intra-operative factors to the respective results, preoperative symptoms, etiologies, size of the perforation, operation methods and postoperative results from the patients were reviewed and analyzed using logistic regression.

Results

Nasal obstruction, crust and epistaxis were common preoperative symptoms. In most cases, perforations were observed to evolve after the patients’ trauma caused from their previous nasal surgery experience. The overall reperforation rate was 48% and turned out to be associated with both large perforation size and unilateral mucosal flap coverage. However, we found no strong evidence that other factors such as graft materials and medical conditions were related with surgical failure. The surgical operations for our examinees resulted in complete healing of epistaxis and whistling, whereas nasal obstruction and crusting persisted after the surgeries. In addition, symptom improvement was negatively correlated with large perforation size and nasal trauma history including previous nasal surgeries.

Conclusion

Precise and complete coverage with bilateral flaps might be the most important factor for successful closure in a septal perforation. Moreover, both trauma history and large perforation size might be at risk for persistent symptoms after septal perforation repair.