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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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July O'Brien K, Kebede H, Porterfield JZ, Patel A, Gupta N. Risk Factors Associated with Complications in Rhinoplasty Using Polydioxanone Plates. Aesthetic Plast Surg 2023; 47:2579-2584. [PMID: 36414724 DOI: 10.1007/s00266-022-03189-8] [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: 09/24/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Polydioxanone (PDS) plates are utilized in septorhinoplasty to reconstruct the nasal septum. Our goal was to analyze factors affecting short- and long-term complications in patients undergoing septorhinoplasty using PDS plates with a particular focus on smoking and diabetes. METHODS This is a retrospective review of patients undergoing septorhinoplasty with PDS plates analyzing risk factors and outcomes. Early complications included infection, hematoma, extrusion, and septal thickening. Late complications included septal perforation, obstruction, revision, and infection. Complication rate was assessed as a function of demographics, diabetes, smoking, autoimmune disease, cancer, and trauma. Multivariate analyses assessed the contributions of these variables, and Chi-square analyses specifically addressed smoking and diabetes. RESULTS A total of 119 patients were included. In multivariate analysis, current smoking had a large negative effect on late outcomes (OR 2.00, 95% CI 0.59-6.55), while diabetes did not show any significant difference. Targeted Chi-squared analysis showed a statistically significant effect of current smoking on increased early complications (OR 3.65, 95% CI 1.67-7.63) and a large but not statistically significant increase in long-term complications (OR 4.20, 95% CI 0.72-22.74). In both models, diabetes was not shown to have an effect on early or late complications. CONCLUSION Current smokers undergoing septorhinoplasty with a PDS plate showed a statistically significant association with early complications and large but not statistically significant association with late complications. Diabetic patients were not found to have an increased complication risk. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kaitlin July O'Brien
- Department of Otolaryngology-Head and Neck, Division of Facial and Plastic Reconstructive Surgery., University of Kentucky, 740 South Limestone E305, Lexington, KY, 40536, USA.
| | - Hana Kebede
- Department of Otolaryngology-Head and Neck, Division of Facial and Plastic Reconstructive Surgery., University of Kentucky, 740 South Limestone E305, Lexington, KY, 40536, USA
| | - James Zachary Porterfield
- Department of Otolaryngology-Head and Neck, Division of Facial and Plastic Reconstructive Surgery., University of Kentucky, 740 South Limestone E305, Lexington, KY, 40536, USA
| | - Amit Patel
- Department of Otolaryngology-Head and Neck, Division of Facial and Plastic Reconstructive Surgery., University of Kentucky, 740 South Limestone E305, Lexington, KY, 40536, USA
| | - Nikita Gupta
- Department of Otolaryngology-Head and Neck, Division of Facial and Plastic Reconstructive Surgery., University of Kentucky, 740 South Limestone E305, Lexington, KY, 40536, USA
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Skochdopole AJ, Bay CC, Grome L, Vorstenbosch J, Yu J, Winocour SJ, Reece EM. Current Surgical Outcomes of Nasal Tip Grafts in Rhinoplasty: A Systematic Review. Plast Reconstr Surg 2023; 152:603e-616e. [PMID: 36723630 DOI: 10.1097/prs.0000000000010257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Refinement of the nasal tip plays an important role in rhinoplasty surgery outcomes and may be considered the most technically challenging aspect of the procedure. Numerous techniques have been described for nasal tip augmentation utilizing grafts. The aim of this study was to systematically review the existing literature on nasal tip grafts and appraise it critically. METHODS A PubMed search was performed to identify journal articles related to nasal tip grafts from the past decade. A total of 44 studies met inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale and Jadad scale were used to appraise 38 observational studies and six randomized trials, respectively, to determine the quality of the studies. RESULTS Critical assessment revealed that the studies were highly variable in focus and encompassed autologous, homologous, and alloplastic grafts. The quality of the data included an average Newcastle-Ottawa Quality Assessment Scale score of 6.5 (out of 9) and Jadad score of 2.5 (out of 5). A majority of studies (86.4%) included objective outcomes using anthropometric measurements and a portion of studies (27.3%) also included patient-reported outcomes. CONCLUSIONS The results of this systematic review suggest that more than one type of nasal tip graft may result in satisfactory outcomes. This review provides an expansive collection of studies on nasal tip grafts, which can serve as an invaluable tool for the plastic surgeon engaging in rhinoplasty.
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Affiliation(s)
- Anna J Skochdopole
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Caroline C Bay
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Luke Grome
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | | | - Jessie Yu
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Sebastian J Winocour
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Edward M Reece
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Texas Children's Hospital
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Ugurlu BN, Celik H, Aslan Felek S, Aktar Ugurlu G, Ciledag N, Kaygusuz H. The Effects of Septorhinoplasty Techniques and Poly-P-Dioxanone Plate Use on Maxillofacial Growth: An Experimental Study. J Craniofac Surg 2021; 32:2892-2895. [PMID: 33674500 DOI: 10.1097/scs.0000000000007607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Since the septum plays a key role in maxillofacial growth, the effect of septorhinoplasty maneuvers and the use of poly-p-dioxanone plate during growth on maxillofacial growth was investigated in our study. Thirty-three New Zealand rabbits each with an age of 8 weeks were included in the study. Maxillofacial computed tomography was performed on all 8-weeks old rabbits. Then, the rabbits were divided into 5 groups randomly. No intervention was done on the rabbits in group 1. Nasal dorsum of the rabbits in the 2nd group were opened, and the mucosae were bilaterally elevated. In the third group underwent limited cartilage resection by preserving the nasal dorsum. Removed cartilage was crushed and placed back between the mucoperichondrial flaps for the rabbits in the 4th group. Crushed cartilage with Poly-P-Dioxanone plate was used for the rabbits in the 5th Group. Maxillofacial computed tomography was performed at the end of the 20th week and growth parameters were investigated. When the group 2 was compared with the control group, the nasal bone length was observed to be significantly shorter (P < 0.05). Group 5 compared with group 4, incisive bone volume remained significantly low (P < 0.05) and malocclusion developed. Nasal bone length was affected negatively in the group that underwent osteotomy and mucosa elevation. Although positive results related to poly-p-dioxanone plate use have been reported for adults, incisive bone development retarded in noses that had not yet reached adult size in our study and the maxillofacial development was affected adversely.
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Affiliation(s)
- Burak Numan Ugurlu
- Department of Otolaryngology, Hitit University Erol Olçok Training and Research Hospital, Corum
| | - Hatice Celik
- Department of Otolaryngology, Health Sciences University Ankara Training and Research Hospital, Ankara
| | - Sevim Aslan Felek
- Department of Otolaryngology, Hitit University Erol Olçok Training and Research Hospital, Corum
| | - Gulay Aktar Ugurlu
- Department of Otolaryngology, Hitit University Erol Olçok Training and Research Hospital, Corum
| | - Nazan Ciledag
- Department of Radiology, Health Sciences University Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hidir Kaygusuz
- Department of Radiology, Health Sciences University Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Zhao F, Sun J, Xue W, Wang F, King MW, Yu C, Jiao Y, Sun K, Wang L. Development of a polycaprolactone/poly( p-dioxanone) bioresorbable stent with mechanically self-reinforced structure for congenital heart disease treatment. Bioact Mater 2021; 6:2969-2982. [PMID: 33732967 PMCID: PMC7930591 DOI: 10.1016/j.bioactmat.2021.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022] Open
Abstract
Recent progress in bioresorbable stents (BRSs) has provided a promising alternative for treating coronary artery disease. However, there is still lack of BRSs with satisfied compression and degradation performance for pediatric patients with congenital heart disease, leading to suboptimal therapy effects. Here, we developed a mechanically self-reinforced composite bioresorbable stent (cBRS) for congenital heart disease application. The cBRS consisted of poly(p-dioxanone) monofilaments and polycaprolactone/poly(p-dioxanone) core-shell composite yarns. Interlacing points in cBRS structure were partially bonded, offering the cBRS with significantly higher compression force compared to typical braids and remained good compliance. The suitable degradation profile of the cBRS can possibly preserve vascular remodeling and healing process. In addition, the controllable structural organization provides a method to customize the performance of the cBRS by altering the proportion of different components in the braids. The in vivo results suggested the cBRS supported the vessel wall similar to that of metallic stent. In both abdominal aorta and iliac artery of porcine, cBRS was entirely endothelialized within 1 month and maintained target vessels with good patency in the 12-month follow-up. The in vivo degradation profile of the cBRS is consistent with static degradation results in vitro. It is also demonstrated that there is minimal impact of pulsatile pressure of blood flow and variation of radial force on the degradation rate of the cBRS. Moreover, the lumen of cBRS implanted vessels were enlarged after 6 months, and significantly larger than the vessels implanted with metallic stent in 12 months.
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Affiliation(s)
- Fan Zhao
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
- Wilson College of Textiles, North Carolina State University, Raleigh, 27606, USA
| | - Jing Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Wen Xue
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Fujun Wang
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Martin W. King
- Wilson College of Textiles, North Carolina State University, Raleigh, 27606, USA
| | - Chenglong Yu
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Yongjie Jiao
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lu Wang
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
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Ishii LE, Tollefson TT. Improving Rhinoplasty With Evidence-Meta-analysis of Perioperative Antibiotics. JAMA FACIAL PLAST SU 2019; 21:18-19. [PMID: 30489608 DOI: 10.1001/jamafacial.2018.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lisa E Ishii
- Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Associate Editor
| | - Travis T Tollefson
- Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
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Gulel O, Tuzuner A, Arslan N, Yerlikaya HS, Yumusak N. The effect of poly-p-dioxanone plate on the protection and vitality of cartilage: An animal study. Laryngoscope 2018; 129:E129-E134. [PMID: 30515851 DOI: 10.1002/lary.27712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/06/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS In septorhinoplasty, septal, auricular, and costal cartilage are often used as autologous graft. Autologous grafts are preferred in nasal reconstruction. The aim of this study was to histopathologically examine the tissue compatibility and the effect on the stability and cartilage vitality of poly-p-dioxanone (PDS) plates. STUDY DESIGN Ten adult New Zealand rabbits were used. METHODS Ten New Zealand rabbits were used. Septal and auricular cartilage sections were removed; one of the two cartilage grafts was left plain, and the other was sutured to a PDS plate. Grafts were placed into the back of the rabbits. After 12 weeks, the graft material was examined microscopically. RESULTS The specimens did not cause any significant foreign body reaction. Within 3 months, a significant degree of color, stability, and stiffness was lost. Microscopically, inflammation, necrosis, and cartilage cell degeneration scores were statistically significantly lower in the grafts using PDS (P < .05), and the vascularization, collagen, and cartilage proliferation scores were found to be statistically significantly higher (P < .05). No statistically significant difference was determined in respect of the bone proliferation scores (P > .05). CONCLUSIONS The use of PDS plates together with cartilage provided mechanical support to the graft. Therefore, changes that disrupt the integrity of the graft, such as inflammation, necrosis, and cartilage cell degeneration, were reduced, and changes that provide greater stability, such as vascularization, collagen, and cartilage proliferation, were increased. LEVEL OF EVIDENCE NA Laryngoscope, 129:E129-E134, 2019.
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Affiliation(s)
- Onur Gulel
- Department of Otorhinolaryngology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Arzu Tuzuner
- Department of Otorhinolaryngology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Necmi Arslan
- Department of Otorhinolaryngology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Huseyin Serdar Yerlikaya
- Department of Otorhinolaryngology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Nihat Yumusak
- Department of Pathology, Faculty of Veterinary Medicine, Harran University, Sanliurfa, Turkey
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Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery. Plast Reconstr Surg 2018; 142:947e-957e. [DOI: 10.1097/prs.0000000000005040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Dayan SH, Bacos JT, Ho TV, Gandhi N, Gutierrez-Borst S. A Pilot Study Evaluating the Efficacy and Safety of ARTISS Human Fibrin Sealant in External Rhinoplasty. Aesthetic Plast Surg 2018; 42:590-597. [PMID: 29340750 DOI: 10.1007/s00266-017-1039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fibrin sealant application in rhytidectomy has previously demonstrated a reduction in adverse events and drainage volume. Fibrin sealant offers multiple potential benefits including decreasing downtime, reducing complication rates, and improving patient satisfaction. In this study, we evaluated the efficacy and safety of ARTISS [fibrin sealant (human)] in external rhinoplasty. METHODS Nine healthy participants between the ages of 18 and 50 seeking external rhinoplasty completed this study. All subjects were randomized into control and treatment groups and then underwent external rhinoplasty, with only the treatment group receiving ARTISS [fibrin sealant (Human)] during surgery. Photographs were taken before surgery and 1 day, 1 week, 1 month, 3 months and 6 months after surgery and used in a blinded assessment of recovery time and esthetic improvement with ecchymosis and satisfaction scales. Subject recovery time, downtime, and self-esteem were evaluated at 1 day, 1 week, 1 month and 6 months after surgery. Recovery time was determined by live assessment of edema and ecchymosis using categorical scales. Subject downtime was assessed through a 30-day patient diary and a downtime questionnaire. Subject self-esteem was evaluated with the Heatherton & Polivy State Self-Esteem Scale. The degree of technical ease with the product was determined by the treating investigator with a 10-cm Visual Analog Scale. RESULTS Patients treated with ARTISS intra-operatively reported significantly higher self-esteem 1 month and 6 months following external rhinoplasty. The ARTISS Easyspray™ Spray Set was rated as technically easy to administer. CONCLUSION The use of ARTISS fibrin sealant in external rhinoplasties is a safe and easy method and may enhance patient self-esteem. Larger studies are warranted to either verify or challenge the validity of our findings. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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10
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Gall R, Bevans S, Robitschek J. Postoperative Nasal Septal Abscess Following Use of 2-Octylcyanoacrylate and Polydioxanone Plate in Open Septorhinoplasty: A Case Series. Ann Otol Rhinol Laryngol 2017; 126:688-692. [PMID: 28831833 DOI: 10.1177/0003489417727013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The employment of 2-octylcyanoacrylate adhesive (Dermabond) to assist graft placement in open septorhinoplasty has been increasingly used to stabilize cartilage grafts. Literature regarding this application has been mixed, with some showing the possibility of increased rates of inflammation, if not infection. We present an original comparative case series involving postoperative septal abscess formation adjacent to caudal strut grafting where both Dermabond and an absorbable polydioxanone (PDS) plate were used. OBJECTIVE To report an original comparative case series of patients who developed a postoperative septal abscess following open septorhinoplasty in the context of Dermabond application to affix cartilage to a PDS plate to facilitate caudal septal strut grafting. DESIGN Retrospective comparative series with relevant clinical photographs, culture studies, and surgical figures. SETTING Tertiary medical treatment facility. RESULTS Two patients underwent primary open septorhinoplasty with placement of an autologous caudal septal extension graft, which was stabilized using a PDS plate and secured into position using both Dermabond and PDS suture. Postoperatively, both patients presented a nasal septal abscess at an average of 8 weeks that required serial drainage and subsequent removal of the PDS plate in 1 of the patients. Cultures demonstrated mixed flora as well as Proteus mirabilis, previously unreported in the nasal septal abscess literature. In comparison to 8 patients who underwent reconstruction with PDS plate alone (without Dermabond application), this represents a relative risk of 15 ( P value = .053) for a septal abscess complication when Dermabond is employed . CONCLUSIONS We present an original case series on our limited, though impactful experience with PDS plate reconstruction using Dermabond to facilitate caudal septal graft placement in open septorhinoplasty. In conjunction with previously reported case series, which demonstrated elevated risk of prolonged inflammation and infection, we would recommend avoidance of subcutaneous Dermabond as an adjunct, particularly in combination with PDS plate utilization.
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Affiliation(s)
- Ryan Gall
- 1 Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Scott Bevans
- 2 Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Jon Robitschek
- 2 Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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11
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Miller MQ, Dighe A, Cui Q, Park SS, Christophel JJ. Regenerative Medicine in Facial Plastic and Reconstructive Surgery: A Review. JAMA FACIAL PLAST SU 2017; 18:391-4. [PMID: 27532945 DOI: 10.1001/jamafacial.2016.0913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The field of regenerative medicine aims at enhancing tissue healing and regeneration through the exogenous addition of therapeutic growth factors and cells, often in combination with tissue-compatible scaffolds. Perhaps the biggest advances in facial plastic and reconstructive surgery (FPRS) in the coming years will be the result of regenerative medicine techniques. While many articles on regenerative medicine have been published in the FPRS literature, to our knowledge there are no reviews that describe both soft-tissue and bony regeneration strategies, including scaffolds, stem cells, growth factors, and platelet-rich plasma. In reviewing the literature, we found that these strategies have produced very promising results and that regenerative medicine has the potential to augment conventional treatment options in the FPRS subspecialty. In the near future, these novel approaches may begin to replace autologous grafting and free tissue transfer in FPRS, the current standards of care. In this review we look at where our subspecialty is today with regard to regenerative medicine and suggest ways for future study and growth.
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Affiliation(s)
- Matthew Q Miller
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
| | - Abhijit Dighe
- Orthopedic Research Laboratories, Department of Orthopedic Surgery, University of Virginia, Charlottesville
| | - Quanjun Cui
- Orthopedic Research Laboratories, Department of Orthopedic Surgery, University of Virginia, Charlottesville
| | - Stephen S Park
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
| | - J Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
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Fuller JC, Levesque PA, Lindsay RW. Polydioxanone plates are safe and effective for L-strut support in functional septorhinoplasty. Laryngoscope 2017; 127:2725-2730. [PMID: 28397278 DOI: 10.1002/lary.26592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 01/30/2017] [Accepted: 02/20/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the safety, efficacy, and result stability of polydioxanone (PDS) plate use for L-strut stabilization. STUDY DESIGN Retrospective analysis of a prospective cohort. METHODS Patients who underwent functional septorhinoplasty with the use of PDS plates between January 2013 and January 2017 were administered the Nasal Obstruction Symptom Evaluation (NOSE) scale pre- and postoperatively at 2, 4, 6, and 12 months. Patient demographics, reason for PDS use, graft type, complications, and outcomes were analyzed. RESULTS Eighty-eight patients aged 34.3 years (standard deviation [SD] = 15.7 years; range, 7.5-71.5 years) were included. All patients were found to have a fracture and/or severe deviation of the L-strut for which the PDS plate was used for rigid support. Mean preoperative NOSE score 65.2 (SD = 22.1) significantly decreased to 19.6 (SD = 21.6) at 7.2 months (SD = 5.5 months) postoperatively. There were no significant differences in NOSE scores between follow-up time points. There was one complication, a septal abscess, and one revision. CONCLUSIONS A PDS plate is a safe and effective material to be utilized in functional septorhinoplasty for patients with a fracture or iatrogenic injury to the septal L-strut or poor quality septal cartilage that requires stability without additional width. Outcomes are stable at 6 and 12 months, after the plate has dissolved. The use of a PDS plate may decrease the need for rib grafting in patients with a history of previous septoplasty and persistent nasal obstruction with a dorsal or caudal C-shaped septal deformity or fracture of the L-strut. LEVEL OF EVIDENCE 2c. Laryngoscope, 127:2725-2730, 2017.
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Affiliation(s)
- Jennifer C Fuller
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, and the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Patricia A Levesque
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, and the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Robin W Lindsay
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, and the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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