Biomechanical strength of human nasal septal lining: comparison of the constituent layers

OBJECTIVE/HYPOTHESIS: Nasal septal perforation is a common complication following surgery involving the nasal septum. Septoplasty, septorhinoplasty, and submucosal resection may result in the inadvertent resection of perichondrium, which may predispose the patient to septal perforations. STUDY DESIGN: Controlled human cadaver study testing the biomechanical strength of the constituent layers of nasal septal lining. METHODS: Uniform samples of nasal septal mucosa, perichondrium, and a composite of both layers were obtained from five fresh human cadavers. The mechanical tensile strength of these layers was evaluated and compared with the Instron 4301 Mechanical Testing System (Canton, MA). RESULTS: Mixed-effects regression analysis demonstrated a significant difference in the tensile strength of the three groups (mean values +/- SD: mucosa, 662 +/- 308 g; perichondrium, 1370 +/- 798 g; composite, 2340 +/- 1252 g). All three pairwise comparisons among the three groups showed a significant difference in tensile strength. CONCLUSION: The perichondrial layer imparts the majority of the biomechanical strength to septal lining. Lining flaps containing both perichondrium and mucosa are stronger than flaps with either perichondrium or mucosa alone. Dissection in the subperichondrial plane during septal surgery provides a stronger septal flap and may prevent the development of nasal septal perforation during nasal surgery.