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Jomah M, Smith O, Villemure-Poliquin N, Cunningham H. Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104240. [PMID: 38447465 DOI: 10.1016/j.amjoto.2024.104240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty. METHODS We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data. RESULTS Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious. CONCLUSIONS AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.
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Affiliation(s)
- Mohammed Jomah
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology - Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
| | - Oakley Smith
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Noémie Villemure-Poliquin
- Otorhinolaryngologie et Chirurgie Cervico-Faciale, Faculté de Médecine, Université Laval, Montreal, Quebec, Canada.
| | - Heather Cunningham
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada.
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2
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Omer GL. Sling-bridge technique: new technique in extracorporeal septorhinoplasty. Front Surg 2024; 11:1369067. [PMID: 38665695 PMCID: PMC11043591 DOI: 10.3389/fsurg.2024.1369067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction Extensive septal deviations requiring advanced correction beyond conventional methods. Extracorporeal rhinoplasty technique, involving complete septum removal, reshaping, and reinsertion. While this technique possesses unacceptable risks, the current study aims to introduce a new approach, the sling-bridge technique to enhance and simplify extracorporeal septorhinoplasty, with more tip control and better integrity within the keystone area. Methods This prospective analytical study included 50 patients with crooked nasal septum who underwent extracorporeal septorhinoplasty between 2021 and 2023 with the new technique. Patients underwent a full clinical examination, consultation and facial analysis to examine the nose shape and identify any abnormalities and asymmetries in the face. Results In the study involving 50 patients, 41 (82%) were males, and with no history of prior rhinoplasty, primarily seeking aesthetic improvements in 44(88%) of participants. Facial asymmetry was observed in 35(70%) of the patients, with 42(84%) individuals exhibiting reduced nasal projection index, nasolabial angle, or nasofrontal angle. The novel technique achieved a straight nose outcome in 45(90%) of patients out of 50, while 5(10%) patients experienced mild deviation linked to extensive preoperative facial asymmetry. Conclusion The surgery yielded highly satisfactory results in most patients, with straight nose outcomes being almost 10 times more likely than mild nose deviation outcomes, and no frank deviations. Throughout the follow-up period, none of the patients had complications, especially those that are common in other techniques attributed with extracorporeal septorhinoplasty, such as dorsal irregularities, septal perforation/deviation or abscesses.
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Affiliation(s)
- Goran Latif Omer
- College of Medicine, University of Sulaimani, Sulaimani, Iraq
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Iraq
- Department of Otorhinolaryngology, Head and Neck Department, Tor Vergata University, Rome, Italy
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3
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Li Y, Guo H, Tang D, Xin Z, Yang W, Yao P. Application of Auricular Cartilage Scaffold Combined With L-Shaped Prosthesis in Asian Rhinoplasty. J Craniofac Surg 2023; 34:1661-1665. [PMID: 37220717 PMCID: PMC10445630 DOI: 10.1097/scs.0000000000009341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/24/2023] [Indexed: 05/25/2023] Open
Abstract
Rhinoplasty is a common surgical procedure in medical cosmetology. From patients with saddle nose deformity to beauty seekers with low and short noses, this surgery is mainly sought to improve the nose's appearance. To investigate the effect of modified auricular cartilage scaffold combined with L-shaped prosthesis in rhinoplasty. This retrospective study included 54 patients who underwent auricular cartilage augmentation rhinoplasty with L-shaped implants in our hospital from July 2018 to July 2021. The function of nasal ventilation and olfaction was inspected. As a result, the degree of nasal tip protrusion and the changes in the superior lip angle of columella were improved. The patients' satisfaction was measured a year after the surgery. Patients who underwent auricular cartilage augmentation rhinoplasty with L-shaped prosthesis were satisfied with the surgery outcomes. Using a protective auricular cartilage scaffold combined with an L-shaped implant for augmentation rhinoplasty reduced the shortage of the application and reinforced the stability of the auricular cartilage augmentation rhinoplasty. At >12 months follow-up, there were no serious adverse effects on nasal ventilation and olfactory function in any of the patients. The presented method made full use of auricular cartilage so that it reduced the harvest of the cartilage. Besides, it achieved the remarkable lift of the nose tip, thus simulating the appearance of costal cartilage rhinoplasty. Furthermore, the risk of implant exposure was efficiently reduced, making it worthy of clinical application.
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Affiliation(s)
- Yi Li
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Hao Guo
- Department of Plastic Surgery, Shanghai Rongyan Medical Cosmetic Outpatient Department, Shanghai, China
| | - Dongsheng Tang
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Zengtao Xin
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Weiyuan Yang
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
| | - Ping Yao
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou
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Hadford SP, Ciolek PJ, Genther DJ. Trilayer temporalis fascia interposition graft: A reliable technique for nasal septal perforation repair. Am J Otolaryngol 2023; 44:103883. [PMID: 37058907 DOI: 10.1016/j.amjoto.2023.103883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Nasal septal perforation (NSP) repair is a complex procedure with variable techniques and success rates. In this study we describe NSP repair using a trilayer interposition graft of temporalis fascia and thin polydioxanone (PDS) plate without intranasal flaps and report outcomes in our patient population. MATERIALS AND METHODS IRB-approved retrospective review of 20 consecutive patients presenting to a tertiary medical center with NSP from September 2018 to December 2020 and who underwent NSP repair via our trilayer temporalis fascia interposition graft. De-identified patient data was obtained from the medical record and stored on an encrypted secure server. Descriptive statistics were examined for each variable. RESULTS All 20 NSP repairs demonstrated durable repair with complete mucosal coverage at last follow-up (average 7 months). Complete resolution of preoperative symptoms was achieved in 85 % of patients, with partial resolution in the remaining 15 %. Of the 20 perforations 25 % were small (<1 cm), 50 % medium (1-2 cm), and 25 % large (>2 cm). The only surgical complication was a single intranasal synechiae. No graft harvest site complications were noted. CONCLUSION The application of a trilayer temporalis fascia - PDS plate interposition graft without intranasal flaps is highly effective for repair of NSP.
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Effectiveness of Absorbable Plates for the Treatment of Nasal Septal Cartilage Fractures. Ann Plast Surg 2022; 89:637-642. [DOI: 10.1097/sap.0000000000003299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Davis SJ, Rossi Meyer M, Misch E, McLeod M, Occhiogrosso J, Yau J, Mims M, Dedhia RD, Sowder JC, Shockley R, Cerrati E, Shaye D, Shockley W, Owen S, Stephan SJ. Septal Perforation Repair Using a Temporoparietal Fascia and Polydioxanone Plate Construct: A Multi-Institutional Analysis. Facial Plast Surg Aesthet Med 2022; 25:212-219. [PMID: 36173756 DOI: 10.1089/fpsam.2021.0421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Nasal septal perforations (NSPs) are notoriously difficult to fix and closure can paradoxically lead to worsening of symptoms, prompting numerous techniques for repair including temporoparietal fascia (TPF)-polydioxanone (PDS) plate interposition grafting. Objectives: To compare rates of NSP closure with TPF-PDS interposition grafting among a variety of institutions with diverse environmental influences and patient-specific factors. Methods: Retrospective review of patients undergoing TPF-PDS interposition grafting at seven different U.S. institutions over 5 years. Outcomes include closure rate, self-reported symptom improvement, change in Nasal Obstruction Symptomatic Evaluation (NOSE) score, and postoperative complications. Results: Sixty-two patients (39 female) with a mean age of 41.5 years were included. Most common perforation location was anterior (53%), and average size was 1.70 cm2. NSP closure with symptomatic improvement was achieved in 95% of participants. Postoperative NOSE scores decreased on average by 42 points. Residual crusting occurred in 29% of patients, independent of external factors. Conclusions: TPF-PDS interposition grafting is highly effective for NSP repair in a wide variety of settings, and NOSE scores correspond well with patient-reported outcomes.
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Affiliation(s)
- Seth J. Davis
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Monica Rossi Meyer
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Emily Misch
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan McLeod
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Jenny Yau
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Marc Mims
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Raj D. Dedhia
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Justin C. Sowder
- Department of Otolaryngology – Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Center for Facial Plastic and Reconstructive Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Ross Shockley
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric Cerrati
- Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Shaye
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William Shockley
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Scott Owen
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of Facial Plastic and Reconstructive Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott J. Stephan
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Levin M, Ziai H, Shapiro J, Roskies MG. Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review. Facial Plast Surg 2022; 38:428-433. [PMID: 35189658 DOI: 10.1055/s-0042-1743251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Nasal septal perforation is an uncommon pathology that is difficult to surgically repair and may significantly impact patients' quality of life. Existing treatments have high complication and failure rates. The use of polydioxanone (PDS) plates to repair septal perforations is an innovative approach that has demonstrated superior outcomes to the conventional techniques. This study aimed to review the literature on PDS plates for nasal septal perforation reconstruction. PubMed, OVID Medline, and OVID Embase databases were searched for relevant articles in June 2021. Search terms included nasal septal perforation, polydioxanone, septal perforation, septal repair, nasal septum, and PDS plate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to for this systematic review. Database searches yielded 80 articles. Seven articles were included representing 74 patients. All studies reported the use of PDS plates in addition to other materials. They all reported closure rates of at least 80%. The majority of studies reported no postoperative complications. Nasal septal perforation reconstruction with PDS plates is a promising approach that has demonstrated positive outcomes. Further larger studies are required to evaluate the long-term efficacy of using PDS plates on patients with septal perforations.
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Affiliation(s)
- Marc Levin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Shapiro
- Temerty Faculty of Medicine, University of Toronto Temerty, Toronto, Ontario, Canada
| | - Michael G Roskies
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto Faculty of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Facial Plastic and Reconstructive Surgery, Sinai Health System, Toronto, Ontario, Canada
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Kim YB, Nam SM, Park ES, Choi CY, Cha HG, Kim JH. Nasal Reconstruction of a Frontonasal Dysplasia via Septal L-Strut Reconstruction Using Costal Cartilage. Cleft Palate Craniofac J 2021; 59:1306-1313. [PMID: 34402319 DOI: 10.1177/10556656211036614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Frontonasal dysplasia (FND) is a rare congenital condition. Its major features include hypertelorism, a large and bifid nasal tip, and a broad nasal root. We present our technique of septal L-strut reconstruction using costal cartilage. DESIGN Retrospective review from June 2008 and August 2017. METHODS Under general anesthesia, 6 patients with FND underwent septal reconstruction using costal cartilage via open rhinoplasty. We reconstructed the nasal and septal cartilaginous framework by placing columellar struts and cantilever-type grafts. RESULTS The patients ranged in age from 6 to 13 years old. All were female. The follow-up period ranged from 8 months to 2 years; we encountered no postoperative complications (infection, nasal obstruction, or recurrence). All patients were satisfied with their nasal appearance. CONCLUSIONS Although the results were not entirely satisfactory from an esthetic point of view, we found that FND can be treated via septal reconstruction with costal cartilage and that the clinical outcomes are reliable and satisfactory. Our approach is a useful option for FND patients.
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Affiliation(s)
- Yong Bae Kim
- WONJIN Plastic Surgery Clinics, Seoul, Republic of Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Chang Yong Choi
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Han Gyu Cha
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jun Hyun Kim
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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9
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Hunter BG. Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series. Ann Otol Rhinol Laryngol 2020; 130:745-751. [PMID: 33158375 DOI: 10.1177/0003489420970592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain. METHOD The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms. RESULTS Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic. CONCLUSIONS This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.
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Affiliation(s)
- Benjamin G Hunter
- St Georges Hospital NHS Trust, London, UK.,Hals-Nasen-Ohren Klinik, Kantosspital St Gallen, St Gallen, Switzerland
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de Gabory L, Boudard P, Bessède JP, Maillard A, Lacomme S, Gontier E, Durand M, Fricain JC, Bénard A, Bordenave L. Multicenter Pilot Study to Assess a Biphasic Calcium Phosphate Implant for Functional and Aesthetic Septorhinoplasty. Facial Plast Surg Aesthet Med 2020; 23:321-329. [PMID: 32700976 DOI: 10.1089/fpsam.2020.0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Importance: A validated biomaterial would have several medical advantages in septorhinoplasties requiring a large-volume graft such as avoiding donor site morbidity, making ambulatory surgery possible, and reducing surgical costs. Objective: To assess the safety and efficacy of a ceramic to treat saddle and crooked noses. The main endpoint was the biocompatibility of the implant. The secondary endpoint was its functional and aesthetic efficacy. Design, Setting, and Participants: The nasal septum (NASEPT) study is a pilot multicenter noncomparative prospective phase IIa clinical trial. The biomaterial tested was a biphasic calcium phosphate implant composed of 75% hydroxyapatite and 25% beta tri calcium phosphate. This versatile material can be used to replace septal skeleton when it is absent or nonusable. We included 25 patients with a multifractured osseous and cartilaginous framework after several traumas or surgeries. The implant placement technique was identical to an extracorporeal septoplasty through the external approach. Main Outcomes and Measures: The primary endpoint was the occurrence of expected adverse and severe adverse events. The secondary endpoints were clinical functional and aesthetic results and histological microscopic modifications. Results: Any extrusion, infection, pain, and epistaxis were observed. All implants were placed in a sagittal, straight, and solid position without extralobular depression. Comparisons between pre- and postoperative symptoms showed that nasal comfort (p < 10-4) and quality of life (p < 10-4) were dramatically improved in all patients. The nasolabial angle (p = 0.047) and the columellar projection (p = 0.024) were improved after surgery. Histological data showed little submucosal inflammation at 6 months with well-differentiated epithelium. The mean follow-up was 23 months: three patients underwent revision surgery for functional or aesthetic details and four implants were removed (16%) owing to a foreign body reaction between 17 and 74 months. Conclusion and Relevance: The NASEPT implant meets functional and aesthetic requirements in complex septorhinoplasties but its long-term biocompatibility needs to be improved. It could potentially avoid donor site morbidity.
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Affiliation(s)
- Ludovic de Gabory
- University Hospital of Bordeaux, Department of Otorhinolaryngology, Bordeaux, France.,CHU Bordeaux, CIC 14-01 IT, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Philippe Boudard
- Department of Otorhinolaryngology, Saint Augustin Hospital, Bordeaux, France
| | | | - Aline Maillard
- CHU Bordeaux, Public Health Unit, Clinical Epidemiology Unit (USMR) & CIC 14-01 EC, Bordeaux, France
| | - Sabrina Lacomme
- University of Bordeaux, UMS 3420 CNRS, US4 INSERM, Bordeaux Imaging Center, Bordeaux, France
| | - Etienne Gontier
- University of Bordeaux, UMS 3420 CNRS, US4 INSERM, Bordeaux Imaging Center, Bordeaux, France
| | - Marlène Durand
- CHU Bordeaux, CIC 14-01 IT, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,INSERM, Tissue Bioengineering, U1026, Bordeaux, France
| | | | - Antoine Bénard
- CHU Bordeaux, Public Health Unit, Clinical Epidemiology Unit (USMR) & CIC 14-01 EC, Bordeaux, France
| | - Laurence Bordenave
- CHU Bordeaux, CIC 14-01 IT, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,INSERM, Tissue Bioengineering, U1026, Bordeaux, France
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Feasibility of a polydioxanone plate as an adjuvant material in rhinoplasty in Asians. Arch Plast Surg 2019; 46:152-159. [PMID: 30934180 PMCID: PMC6446022 DOI: 10.5999/aps.2018.00885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/04/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Nasal framework-supporting procedures such as septal extension grafts, derotation grafts, and columellar strut grafts are usually required in rhinoplasty in Asian patients because the skin envelope is tight, but the nasal framework is small and weak. Autologous materials are preferred, but they have some limitations related to the amount that can be harvested and the frequency of use. Therefore, synthetic materials have been used to overcome these limitations. METHODS A total of 114 patients who received a polydioxanone (PDS) plate as an adjuvant material in rhinoplasty from September 2016 to August 2017 were retrospectively investigated. The PDS plate was used as to support the weak framework and to correct the contour of the alar cartilages. The PDS plate was used for reinforcement of columellar struts and septal L-struts, alar cartilage push-down grafts, fixation of septal extension grafts, and correction of alar contour deformities. RESULTS Primary and secondary rhinoplasty was performed in 103 and 11 patients, respectively. Clinically, no significant inflammation occurred, but decreased projection of the tip was observed in seven patients and relapse of a short nose was noted in five patients. CONCLUSIONS PDS plates have been used in the United States and Europe for more than 10 years to provide a scaffold for the nasal framework. These plates can provide reinforcement to columellar struts, L-struts, and septal extension grafts. In addition, they can assist in deformity correction. Therefore, PDS plates can be considered a good adjuvant material for Asian patients with weak and small nasal cartilage.
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Dayan SH, Ashourian N. Polydioxanone Absorbable Plate for Cartilaginous Grafting in Endonasal Rhinoplasty: A Randomized Clinical Trial. JAMA FACIAL PLAST SU 2016; 18:47-53. [PMID: 26501937 DOI: 10.1001/jamafacial.2015.1492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The caudal septal extension (CSE) graft maneuver commonly is used to adjust the nasal tip projection. It can, however, be difficult to stabilize and straighten the CSE graft, especially when the procedure is performed through an endonasal approach. Because the stabilization and correct positioning of the CSE graft are vital for achievement of the desired outcome, new approaches must be found that facilitate the technical ease of this procedure. OBJECTIVE To assess the safety and efficacy of the polydioxanone (PDS) absorbable plate in CSE graft procedures performed via an endonasal approach. DESIGN, SETTING, AND PARTICIPANTS In an open-label, 2-arm parallel trial, 30 patients who requested a surgical nasal correction and required a CSE graft performed via an endonasal approach were randomized into 2 groups of 15 patients each. All patients underwent endonasal rhinoplasty at a single center from February 17, 2011, to December 26, 2013. Depending on their treatment group, patients received a CSE graft with or without a PDS plate. Data were collected and evaluated from November 24, 2010, to January 19, 2015, when final follow-up occurred. Data were analyzed based on an evaluable population. INTERVENTIONS Endonasal rhinoplasty with or without the use of a PDS plate. MAIN OUTCOMES AND MEASURES Technical difficulty assessed using a visual analog scale (range, 0-100; higher scores indicate increased difficulty of use), surgeon and blinded evaluator satisfaction with the graft assessed using a 4-point categorical scale (1 indicates highly satisfied; 4, unsatisfied), change in nasal tip projection, and complications at 30, 60, 180, and 365 days after surgery. RESULTS Twenty-seven patients (13 in the PDS group and 14 in the non-PDS group) completed their 6-month postoperative visit, and 19 patients (10 in the PDS group and 9 in the non-PDS group) completed the entire study (12 months). The mean (SD; range) surgeon-assessed visual analog scale score for ease of use was 46 (13; 25-64) mm for the 15 patients in the non-PDS treatment group and 17 (10; 7-48) mm for the 15 patients in the PDS group (P < .001). The surgeon's satisfaction with the graft did not differ significantly between the PDS and the non-PDS groups (P = .34), and the nontreating blinded evaluator's assessment of standardized photographs taken at the time of the graft placement and at postoperative days 30, 60, 180, and 365 did not establish any significant differences between the 2 groups (P > .99). Postoperative change in the nasal tip projection at 365 postoperative days compared with 30 postoperative days was significantly lower in the PDS group compared with the non-PDS group (-0.31% vs -6.5%; P = .04), thus increasing the long-term stability of the graft in the PDS group. A single incident of infection was observed in each group along with no episodes of rejection or extrusion. CONCLUSIONS AND RELEVANCE In this study, use of a PDS plate in CSE graft procedures was associated with less technical difficulty than CSE graft procedures without use of a PDS plate and with reduced long-term variations in the nasal tip projection after the graft placement. LEVEL OF EVIDENCE 1. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01225250.
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Affiliation(s)
- Steven H Dayan
- DeNova Research, Chicago, Illinois2Chicago Center for Facial Plastic Surgery, Chicago, Illinois3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois Medical Center, Chicago
| | - Nazanin Ashourian
- DeNova Research, Chicago, Illinois2Chicago Center for Facial Plastic Surgery, Chicago, Illinois
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