Septal Perforation Repair Research Articles

Septal perforation repair using costal chondro-perichondrial graft: a case report

Septal perforation is an anatomical defect of the nasal septum that leads to impaired nasal function, including obstruction and respiratory issues. In this study, a novel surgical approach was introduced to address septal perforations, focusing on the use of costal composite chondro-perichondrial grafts bilaterally in a symmetric manner. This composite graft, composed of costal cartilage and perichondrium, provides mechanical support, aids vascularization, and minimizes perichondrial shrinkage. A case study of a 23-year-old patient with septal perforation resulting from multiple rhinoplasty procedures is presented. The surgical procedure involved the use of a composite graft to close the septal perforation and correct the nasal deformity. The postoperative results demonstrated successful septal perforation closure and relief from nasal discomfort. This study highlights the advantages of this method, particularly its simplicity and straightforward surgical procedures for closing septal perforations of various sizes, and its suitability for rhinoplasty surgeons who are familiar with costal cartilage harvesting.

Engineered autologous nasal cartilage for repair of nasal septal perforations - a case series.

This phase I clinical trial assessed the use of autologous nasal chondrocyte tissue-engineered cartilage (N-TEC) for functional repair of nasal septal perforations (NSP). The most widely used technique to treat NSP, namely interposition grafting with a polydioxanone (PDS) plate combined with a deep temporal fascia (DTF) graft, is still suboptimal towards patient satisfaction and revision rates. Patients (n=5, all female, age range: 23-54 years) had a 0.5-2.0cm diameter NSP. N-TEC was manufactured by expansion and 3D culture of autologous nasal septum chondrocytes into Chondro-Gide® collagen membranes. N-TEC was then shaped intraoperatively and enveloped in the harvested DTF before suturing it into the NSP. Safety (primary outcome) was assessed by the number of serious adverse reactions (SAR) until 12 months. Secondary outcomes included feasibility, assessed by surgical graft manipulation, and efficacy, assessed using subjective scoring (Nasal Obstruction Symptom Evaluation, NOSE, and Visual Analogue Scale, VAS, scores) and objective breathing function tests. Structural closure of NSP after 12 months was defined using endoscopy and computed tomography (CT) scans. NSP treatment by N-TEC implantation was safe and feasible, as no SAR and no challenge in graft manipulation was recorded for any of the patients. One year postoperative, subjective scoring improved in all patients, unless already optimal (average improvement of 23 and 28.6 points out of 100 respectively for NOSE and VAS scores). Objective respiratory function overall confirmed - with the exception of one case - the observations above (average improvement of 172 ml/s). NSP were closed and the mucosae completely healed in three patients. Autologous N-TEC is a valid treatment for NSP and warrants further clinical tests.

Anticoagulation management for cardiopulmonary bypass using TEG® 6 s in a patient receiving both heparin and dabigatran

BackgroundIt is difficult to evaluate adequate dose of heparin for cardiopulmonary bypass (CPB) by activated clotting time (ACT) in a patient receiving both heparin and dabigatran because dabigatran can also prolong ACT. We evaluated the effect of dabigatran by thromboelastography (TEG) to determine adequate heparin dose for CPB.Case presentationAn 81-year-old woman receiving both heparin and dabigatran was scheduled for an emergency surgical repair of iatrogenic atrial septal perforation. Although ACT was prolonged to 419 s, we performed TEG to distinguish anticoagulation by dabigatran from heparin comparing R in CK and CHK. As the results of TEG indicated residual effect of dabigatran, we reversed dabigatran by idarucizumab and then dosed 200 U/kg of heparin to achieve adequate anticoagulation for CPB by heparin.ConclusionsTEG could help physicians to determine need for idarucizumab and also an adequate dose of heparin to establish appropriate anticoagulation for CPB.

Septal Perforation Quality of Life questionnaire (SEPEQOL): validation of a new instrument to assess patients undergoing endoscopic repair of a nasal septal perforation

PurposeNasoseptal perforations (NSP) are a clinically heterogeneous group of disorders with a wide range of available treatments. Patient-reported outcome measures (PROMs) can provide valuable insights for assessing clinical and surgical outcomes. This study aims to develop and validate a novel-specific questionnaire for patients with NSP.MethodsA multi-centre prospective observational study was conducted at two tertiary referral hospitals. “Septal Perforation Quality of Life” (SEPEQOL) was developed by a committee of experts. The psychometric properties, including reproducibility, reliability, validity, and responsiveness, were assessed.ResultsThe study included 96 symptomatic NSP patients and 30 healthy controls. SEPEQOL internal consistency was satisfactory [Cronbach´s α = 0.7843; 95% confidence interval (CI), 0.702–0.856]. Test-retest reliability was excellent, demonstrated by the absolute intraclass correlation (ICC = 0.974; 95% CI, 0.935–0.989, P-value < 0.001) and Bland-Altman plot (line bias = 1.6 ± 4.57; 95% CI -0.54–3.74, P-value < 0.001). The mean total SEPEQOL score was higher before surgery (25.16 ± 1.65) compared to 6-months after the procedure (13.72 ± 11.39), with a mean difference of 12.19 [standard deviation (SD) 10.76], P-value < 0.001.ConclusionsSEPEQOL is reliable, consistent, valid, and sensitive to change over time. SEPEQOL assesses the impact of health-related quality of life on NSP and its management in clinical practice. Moreover, it is easy to apply in clinical settings with minimal burden.

Endoscopic repair of nasal septal perforation with anterior ethmoidal artery flap using tunnel technique.

Septal perforations (SPs) present a distinct challenge. There are many described surgical approaches with variable success rates. The goal of this study is to describe a new technique in repairing SP. A case series of eighteen patients with anterior septal perforation who underwent endoscopic repair with the "tunnel technique" based on anterior ethmoid artery flap (AEA) were analyzed. Demographic data, etiology, size of perforation, and success rate were collected. Eighteen cases with male predominance (67%) were enrolled from 2019 to 2022. The average perforation size was 1.5 cm (0.5- 3.6 cm). The success rate of complete SP closure was 94% (n = 17/18) with no complications after surgery. The patients were followed up for 7 ± 5.2 months. AEA flap reconstruction with the tunnel technique is associated with favorable outcomes in SP closure. The tunnel technique provides a useful flap bolster and minimizes the use of other supportive measures. This technique offers an addition to other techniques for septal perforation repair. Level 4.

Prospective evaluation of nasal septal perforation repair with absorbable plate and temporalis fascia in early adolescent patients

ObjectivesIn the pediatric population, nasal septal perforations (NSP) are rare, and management is not well described. The use of various techniques has been reported in adults, including the use of interposition grafts, however this technique has not been described in the pediatric population.Our hypothesis is that the closure rate using absorbable d-lactide and l-lactide (each 50 %), polymer (PDLLA) plates as interposition grafts with temporalis fascia for NSP repair in the pediatric population will be an effective method compared to previous techniques. MethodsChart review was performed on patients who underwent NSP repair before June 2021, results were compared to a prospective evaluation of an interposition plate graft for repair at a tertiary care children's hospital. ResultsFifteen patients via previous techniques and 5 patients via PDLLA and fascia graft were reviewed. Etiology of perforations included 45 % idiopathic, 25 % traumatic, and 15 % iatrogenic. In the previous techniques group, 10 were male, mean (median) age 14.4 years (15.2). Average size of NSP was 12.6 mm ± 6.6 mm (SD). 14/15 (93 %) patients had resolution of symptoms at 10-week follow-up, and 2/15 (13 %) required repeat repair. Five prospective patients were repaired with a PDLLA and fascia interposition graft, 4 were female, mean (median) age 14.6 years (Nassif and Scott, 2021 Feb 1) [14]. Average size of NSP was 11 mm ± 2.2 mm (SD). 100 % had resolution of symptoms at 10-week follow-up, 0 needed repeat surgery. No significant difference was found in size of NSP or in need for repeat procedure (p > 0.05) between the groups. ConclusionUse of absorbable PDLLA interposition grafts with temporalis fascia for NSP repair in the pediatric population is effective at closing and resolving symptoms associated with NSP.

Simultaneous Rhinoplasty and Septal Perforation Repair Using the Bone-Cartilaginous Unit.

Various techniques are employed for septal perforation repair but success rates still vary. Numerous mucosal flaps are used for septal perforation closure; however, a scaffold is essential for proper positioning and enhanced mucosal growth. The aim of this study was to assess the effectiveness of utilizing a septal bone/cartilage composite graft (BC unit) to close septal perforations in rhinoplasty patients and evaluate patient satisfaction. This case series included patients with septal perforation undergoing rhinoplasty and perforation repair between 2019 and 2023. BC units were used to cover the cartilaginous perforations in all patients. Patients were followed for a minimum of 1 year, assessing surgical results and postoperative satisfaction with the 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). In this study, 31 patients (22 female, 9 male), with a mean [standard deviation] age of 34.80 [10.31] years (range, 19-59 years), were enrolled. Nine had previousl undergone septoplasty, while four had undergone septorhinoplasty. The preoperative perforation size ranged from 6 to 27 mm (mean, 14.1 mm). At final follow-up, 26 cases (83.8%) achieved complete closure, while 3 had incomplete closures, and 2 experienced reperforation. Analysis revealed a notable mean decrease of 31.93 [26.47] in obstruction domain scores (SCHNOS-O) and a mean decrease of 44.19 [25.37] in cosmesis domain scores (SCHNOS-C). Septal perforation repair and rhinoplasty can be safely and effectively performed concurrently with BC units for suitable candidates.

Successful repair of recurrent ventricular septal perforation after myocardial infarction using double patch technique via right ventriculotomy: a case report

BackgroundPost-myocardial infarction (MI) ventricular septal perforation (VSP) is a rare but life-threatening complication. Surgical repair is challenging and carries significant risks, particularly in the context of recurrent VSPs. This case study presents a patient with recurrent VSP after initial surgical repair following myocardial infarction.Case presentationA 65-year-old male were re-administered to our hospital due to recurrent VSP. He was during follow up after undergone emergency VSP closure surgery 2 months earlier, utilizing the bovine double patch technique via left ventriculostomy. The initial VSP was located in the apical part of the interventricular septum, while the recurrent VSP appeared in the upper middle portion of the interventricular septum (Fig. 1). As the previous patch remained intact, the second surgery employed the bovine double patch technique via right ventriculostomy. The patient’s condition remained stable without the development of heart failure symptoms.ConclusionRepairing recurrent VSPs remains a challenge, necessitating the mastery of appropriate approaches to achieve optimal outcomes. Further research and guidelines are required to refine management strategies for recurrent VSPs.

Predictors of Success of Endonasal Septal Perforation Repair: A 10-Year Experience.

Background: There is no consensus on optimal repair technique for nasal septal perforations (NSPs). Objective: To measure success rate and evaluate predictors of success for NSP repair. Methods: Medical records of patients who underwent NSP repair from 2010 to 2020 were reviewed. Included patients had at least 60 days of postsurgical follow-up. Surgical technique involves an endonasal approach; subperichondrial dissection with local flap mobilization; and multilayer closure using cartilage interposition graft, fascia graft, and mucoperichondrial flaps. A chi-squared test or Fisher exact test was used for statistical analysis. Results: Eighty-one repairs were performed with a closure rate of 86%. The median patient age was 46 years (range 13-77); 34.6% of perforations were ≥2 cm. Conchal (77.8%), rib (7.4%), or septal (7.4%) cartilage was used as graft material. A complication rate of 8.6% was reported. Perforation size or graft material had no impact on successful closure rate. Of patients with failed repairs, 55% had perioperative complications or conditions associated with poor healing. Conclusion: An endonasal approach for NSP repair showed a high success rate across diverse presentations; however, NSP repair was significantly more likely to be successful in patients without perioperative complications or pre-existing conditions associated with poor wound healing.

A Case of Ventricular Aneurysm in a Remote Stage after Repair of a Ventricular Septal Perforation with Massive Thrombus in the Aneurysm

A Case of Ventricular Aneurysm in a Remote Stage after Repair of a Ventricular Septal Perforation with Massive Thrombus in the Aneurysm

Online survey to determine realistic success rates and trends in surgical septal perforation repair

High success rates (SR) for surgical septal perforation repair (SPR) of over 90 % are reported in the literature. We think that realistic SR are significantly lower and wanted to confirm this thesis with the help of a survey among ear, nose, throat ENT specialists from Germany. Surgical trends were also queried. An anonymous online survey among ENT specialists in Germany was conducted. 356 doctors participated. The collected SR were statistically evaluated, and the operative trends were analysed. It applies a significance level α = 0.05. The SR were collected for 3 different size categories (<1 cm, 1-2 cm, >2 cm). The SR for SPR <1 cm (median 79 %) was higher than that for 1-2 cm (60 %) and >2 cm (40 %). Surgeons estimated SR significantly higher (90 %, 75 %, 50 %; p-value <0.001 each) than non-surgeons (80 %, 50 %, 25 %). Hospital-based physicians (90 %, 70 %, 50 %) reported significantly higher SR than ambulatory physicians (80 %, 50 %, 30 %, p-value <0.001 each). No linear relationship was found between the total number of SPR performed and SR (r <1cm = 0.16, r1-2cm = 0.18, r >2cm = 0.19). Most SPR were performed with the bridge flap technique (73 %), a closed surgical approach (85 %), an interposition graft (74 %) and postoperative splinting (94 %). The subjective SR suggest that the SR of SPR is lower than described in the literature. This may be due to short follow-up times, small patient populations and a retrospective design of existing studies. The variety of surgical possibilities confirms the complexity of SPR. Optimising the design of future studies could help to collect realistic SR.

Application of Biologic Graft in Nasal Septal Perforation Repair.

Objective: To explore the clinical outcome when biomaterials are used to repair nasal septal perforations. Methods: A total of 12 patients were treated. The nasal septum was dissected via endoscopic approach. A 4 cm × 7 cm biologic graft (Biodesign® Tissue Graft) was folded to form a double layer, was placed over the perforation, and was affixed into place using suture. Results: Follow-up ranged from 2 to 8 months after the operation. One patient was not completely healed and presented with a remaining defect of about 2 mm × 8 mm in the upper part of the nasal septum. The remaining 11 patients healed completely. Conclusion: Using a biologic graft to repair nasal septal perforations is an easy operation as it prevents the need to take autologous tissue from the patient, allows for a repair to be performed without creating septal flaps, and has good histocompatibility. It is a safe and effective method that can be used clinically.

Validated Symptom Outcomes Following Septal Perforation Repair: Application of the NOSE-Perf Scale.

The Nasal Obstruction Symptom Evaluation (NOSE)-Perf scale was developed and validated to measure symptoms associated with nasal septal perforations. This study reports the application of the NOSE-Perf scale to evaluate symptom change following septal perforation repair. Patients with NOSE-Perf evaluations ≥6 months following attempted perforation closure from July 2018 to December 2021 utilizing bilateral nasal mucosal flaps with an interposition graft were eligible for study inclusion. Change in NOSE-Perf scores were noted. Patient demographics, perforation size, and concurrent functional procedures were analyzed for impact on symptom outcomes. One-hundred and seventeen patients met the study criteria. Seventy-nine (67.5%) of the patients were female and the mean (range) age at surgery was 47.3 (14-78) years. Repair failure was noted in 7 (6.0%) patients. Mean (SD) preoperative NOSE-Perf score was 25.3 (95% CI, 23.5-27.1) and postoperative score was 7.9 (95% CI, 6.5-9.3). Minimal clinically important difference (MCID) was estimated and greater than 91% of patients had improvement above this threshold. Patient age, perforation size, or concurrent functional procedures did not impact outcomes. Postoperative scores at short (2-4 months), intermediate (5-8 months), and long-term (≥9 months) time periods showed significant improvement (all p < 0.001) compared to preoperative NOSE-Perf scores. Significant reduction in nasal symptoms as measured by the NOSE-Perf scale is noted following bilateral mucosal flap repair. Although the nose does not completely normalize following repair, clinically important improvement was noted in at least 91% of patients. The NOSE-Perf scale is positioned to play a role in the standardization of septal perforation evaluation and outcomes assessment. 4 Laryngoscope, 134:3067-3072, 2024.

Fascia Lata-Fat Island Graft in Septal Perforation Repair.

Objective: To measure the success of the fascia lata-fat island graft technique in septal perforation repair as measured by nasal endoscopic examination. Background: This study presents the results of using fascia lata-fat island, a different graft technique, for the repair of septal perforations, offering an alternative to this challenging procedure. Methods: This retrospective study assesses nasal septal perforation repair using the fascia lata-fat island graft technique performed by a single surgeon. Inclusion criteria involved completing 12-month follow-ups within a 3-year review period. Success rates were calculated and evaluated alongside patient characteristics. Results: The median (range) age of the 25 patients included in the study was 34 (25-45) years and 72.0% were men. The septal perforation size of all patients was >2 cm and the etiological cause in all of them was previous septal surgery. All patients were followed for 12 months. The perforation was completely closed in 23 of 25 patients (92%). Conclusion: Using a different graft with an open rhinoplasty approach, we achieved a high success rate in patients with large septal perforations, followed for 1 month with nasal stenting and an average follow-up duration of 12 months.

Septal Perforation Repair with Temporalis Fascia and PDS Plate

Septal Perforation Repair with Temporalis Fascia and PDS Plate

Nasal Septal Perforation Repair with a Unilateral Mucosal Flap and a Contralateral Skin Graft

Nasal Septal Perforation Repair with a Unilateral Mucosal Flap and a Contralateral Skin Graft

The Use of Platelet-Rich Fibrin and Polypropylene Mesh in Repair of Nasal Septal Perforation.

In this study, we aimed to investigate the effectiveness of the use of polypropylene mesh and platelet-rich fibrin (PRF) in nasal septal perforation (NSP) repair. Prospective experimental study. Laboratory. Twenty-four adult male New Zealand rabbits were used in our study. In all subjects, a 10 × 10 mm perforation was created in the septum. The subjects were divided into 3 equal groups according to the different methods used in perforation closure. The bilateral mucosal flap was used in the control group, polypropylene mesh + bilateral mucosal flap in the mesh group, and polypropylene mesh + bilateral mucosal flap + PRF in the mesh + PRF group. NSP treatment success rate was found to be significantly higher in the mesh (4/6, 66.7%) and mesh + PRF (6/6, 100%) groups compared to the control group (0/6, 0%). Re-epithelialization score was higher in the mesh + PRF group and the control group compared to the mesh group. While the necrosis, neutrophil, and abscess scores were highest in the mesh group, they were similar to the control group in the mesh + PRF group. While polypropylene mesh significantly increases the success rate in NSP repair, it causes severe inflammatory responses. However, when polypropylene mesh is combined with PRF, it both increases the rate of perforation closure and significantly reduces the complications associated with the use of mesh.

A Novel Technique for Septal Perforation Repair: Fascia Lata Graft.

Nasal septal perforation (NSP) is an anatomical defect involving the mucosa, cartilage/bone of the nasal septum, most commonly caused by septoplasty. Spontaneous healing of a perforated septum is rare; instead, it tends to worsen over time. Several surgical approaches have been described for NSP repair. In this study, the authors present a novel technique using only fascia lata graft for repairing NSP of various sizes. The authors conducted a retrospective study, including 23 patients who underwent NSP repair between January 2020 and January 2022. Grafts were harvested, and the perforation was accessed through an open rhinoplasty approach, followed by insertion and suturing of the graft. The mean size of the septal perforations was 2.13 mm horizontally and 2.14 mm vertically. The mean follow-up period was 12 months. Complete closure of NSP was achieved in 21 out of 23 patients (91.30%). Among the cases, 17 were males (11.76%), and the age ranged from 20 to 43 years with a mean of 36.5. Eight cases (50%) were smokers. At 12 months postoperatively, 3 medium-sized NSPs were closed successfully, whereas 2 large NSPs did not achieve closure due to smoking. The fascia lata technique for NSP closure is a safe and reliable approach with a high success rate, which should be considered for patients with NSP.

Combined endoscopic sinus surgery and endonasal septal perforation repair: Symptom outcomes and perforation closure rates.

Combined endoscopic sinus surgery and nasal septal perforation repair is technically feasible. NOSE-Perf is a recently developed patient-reported outcome measure for nasal septal perforation. The decision to perform combined ESS and NSP repair should be made on a case-by-case basis.

Rhinoplasty with Concurrent Repair of Septal Perforation.

Concurrently performing septal perforation repair and rhinoplasty is challenging. Successful management of patients who require or desire these procedures performed simultaneously can be achieved with appropriate preoperative workup and optimization, thoughtful surgical planning, masterful execution, and diligent postoperative care. Consideration of perforation etiology and status of the perforation along with overall nasal health are the foundation upon which surgery may be planned. Preoperative evaluation to determine locations of obstruction, aesthetic goals, and feasibility of procedure is required. Rhinoplasty techniques and perforation closure techniques may share common maneuvers making concurrent surgery possible. Surgical techniques to achieve perforation closure often influence rhinoplasty considerations, and vice versa. Care must be taken to account and possibly even to capitalize on these influences. Perforation closure techniques that may be readily combined with rhinoplasty include interposition grafting and intranasal mucosal rotational advancement flaps, which may exert forces upon the nose with aesthetic or functional consequences. Rhinoplasty techniques targeting any third of the nose also can impact tension or available mucosa for perforation closure techniques. Combining these procedures can be very rewarding for the patient and provider but should be considered responsibly and thoughtfully.