Abstract

Airway collapse can occur when the forces of inhalation overpower the strength of the nasal lining flap. The authors established an animal model of the reconstructed nasal airway, and examined mechanical properties of tissue composites based on various materials. Twenty-three Sprague-Dawley rats were divided into three experimental groups: control (n = 5), irradiated homologous costal cartilage (IHCC, n = 10), and expanded polytetrafluoroethylene (ePTFE, n = 8). Two dorsal skin flaps represented nasal lining and skin envelope. No framework, an IHCC or ePTFE rim graft was used as framework. At three weeks, changes in the cross-sectional area of the lining flap were measured when negative pressure was applied. En-bloc specimens containing the graft and soft tissue were examined for histological change and tissue ingrowth. Reduction of cross-sectional area with simulated inhalation was 87.74% in the control group, 82.76% (IHCC), and 67.29% (ePTFE). Cross-sectional reduction was significantly less in ePTFE group than control group (p = 0.004) and IHCC group (p = 0.001). The difference was not significant in the control and IHCC groups. There was histologic evidence of tissue ingrowth in the ePTFE group. This novel animal model of nasal airway reconstruction supports the use and potential benefit of using ePTFE for prevention of airway collapse.

Highlights

  • The nose is quite difficult to reconstruct with satisfactory results because of its complex topography and robust structural integrity[1]

  • If the results suggest improved mechanical properties, this would support a paradigm shift in human nasal reconstruction favoring alloplast materials

  • The ePTFE group showed significantly less reduction compared to the control group (p = 0.004) and irradiated homologous costal cartilage (IHCC) group (p = 0.001)

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Summary

Introduction

The nose is quite difficult to reconstruct with satisfactory results because of its complex topography and robust structural integrity[1]. Soft tissue must sandwich a framework to create form and a patent airway[1,2,3,4,5,6,7,8]. Negative pressure in the airway can overcome the support of the cartilage framework and tissue, and resulted in the collapse of airway, which may lead to airway obstruction or difficulty of breathing in our clinical observation (Video 1). Cartilage remains the gold standard in nasal reconstruction, alloplast support may confer better strength and airway protection. Because ePTFE is biocompatible, surrounding tissue is expected to grow into its microporous structure, and to create a bond between the lining flap and ePTFE9–14. If the results suggest improved mechanical properties, this would support a paradigm shift in human nasal reconstruction favoring alloplast materials

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