The effects of different suture materials in the nasal cavity

Submucosal Trans-Septal Suturing Technique After a Septal Extension Graft with Porous High-Density Polyethylene: A Technical Report

BACKGROUND

Porous high-density polyethylene (pHDPE) is an alternative material for a septal extension graft (SEG) in oriental rhinoplasty when autologous cartilage is limited. Although nasal packing (NP) and trans-septal suturing (TSS) techniques are routine procedures to obviate the dead space after septoplasty, they are associated with certain discomforts and complications.

OBJECTIVE

To investigate the application of a submucosal trans-septal suturing (STSS) technique after SEG with pHDPE.

METHODS

A prospective study was conducted on 60 female participants who underwent SEG with pHDPE. The participants were randomly divided into the NP group and STSS group. The extra surgical duration of NP and STSS, pain, nasal obstruction, and sleeping disturbance as well as postoperative complications were recorded and compared between groups.

RESULTS

No significant difference was found between group NP and group STSS in terms of mean age. The mean extra surgical duration of group STSS was significantly longer than group NP. There were significant higher pains of group NP at 24 hours and 48 hours postoperatively, compared with group STSS. The NP group also experienced significantly more nasal obstruction and sleep disturbance within 48h postoperatively compared to the STSS group. There was one infection in each group, minor bleeding in two NP patients, and one STSS patient. There was no major bleeding, hematoma, graft exposure, or septal perforation in both groups.

CONCLUSION

Although STSS needs a longer extra surgical duration than NP, it significantly improves the patient's postoperative comfort with a faster return to normal respiration compared to NP.

LEVEL OF EVIDENCE I

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The Time to Spontaneous Drop of Polyglactin 910 (Vicryl) in the Nasal Cavity

Sutures play a crucial role in closing mucosal incisions during endoscopic nasal surgery. The duration until the spontaneous drop of polyglactin 910 (Vicryl) sutures in the nasal cavity remains uncertain. To investigate this, we examined the medical records of patients who underwent septoplasty, inferior turbinate reduction, or endoscopic modified medial maxillectomy with polyglactin 910 sutures. The sutures were counted and monitored during follow-up visits, and removal occurred only if patients reported discomfort. In our study of 124 patients, a total of 453 sutures were placed during surgery. Eighteen sutures had to be intentionally removed due to discomfort. Importantly, no surgical site infections were observed during the follow-up period. We found that sutures on the lateral nasal wall persisted longer than those on the nasal septum, with respective half-lives of 70 days and 64 days (p = 0.0071). In conclusion, using polyglactin 910 sutures in nasal surgery and allowing them to dissolve naturally in the submucosa is an effective approach. The sutures exhibit longer persistence on the lateral nasal wall compared to the nasal septum.

The Effect of Absorbable and Non-Absorbable Sutures on Nasal Width Following Cinch Sutures in Orthognathic Surgery

Background: Non-absorbable materials (nylon) are always used in cinch sutures to maintain nasal width and to improve harmonious facial symmetry in orthognathic surgery. However, a few drawbacks of nylon materials have been clinically reported following orthognathic surgery, such as nasal irritation and exposure of the sutures. An absorbable material (PDS) has been proposed in cinch sutures, not only to avoid the complications of nylon but also to stabilize the nasal width for a long-term follow-up. Methods: Fifty-seven patients with Angle’s malocclusion classification III receiving orthognathic surgery were enrolled in this study. A non-absorbable material (nylon) and an absorbable material (PDS) were utilized for the cinch sutures. Pre-operative (T1) and post-operative six-month (T2) craniofacial 3D images were collected for all patients to measure the alar curvature (Ac) width and the alar base (Al) width. A significance level of p < 0.05 was applied in the statistical analysis. Results: With the approval of IRB, cinch suturing was performed with nylon in 29 patients and with PDS in 28 patients. Pre-operative Ac and Al distances showed no significant difference between these two groups. There were also no significant differences between the suture materials in the peri-operative change in nasal width, including Ac (nylon: 1.999 ± 1.40; PDS: 1.484 ± 0.97; p = 0.112) and Al (nylon: 1.861 ± 1.66; PDS: 1.115 ± 0.92; p = 0.056). Conclusions: For cinch sutures in orthognathic surgery, PDS can maintain the peri-operative nasal width similarly to nylon; additionally, it can be absorbed in a timely manner without the drawbacks of non-absorbable materials.

Nasal Septal Chain Suture: A New Suturing Technique

As a new technique for suturing the nasal septum, the nasal septal chain suture has been described in this study, and compared with nasal packing and the quilting suture technique in terms of patient comfort after septoplasty. A total of 75 patients were evaluated in 3 groups: Merocel nasal packing group, absorbable quilting suture group, and nonabsorbable nasal septal chain suture group. The symptoms of these patients were evaluated using the nasal obstruction symptom evaluation (NOSE) scale and rhinomanometry measurements. The NOSE scale values were significantly higher on the postoperative 1st and 3rd days in the nasal packing group (P < 0.001 and P < 0.001, respectively). The nasal resistance was significantly lower (P = 0.011) and the nasal airflow significantly higher (P < 0.001) in the suture groups on the postoperative 3rd day. The use of nasal packing was found to shorten the surgery duration significantly (P < 0.001), while there was no difference between the 2 suture groups (P = 1.000). There was significantly severe pain during the removal of the nasal packing when compared to the nasal septal chain suture removal (P < 0.001), but there was no difference in the bleeding (P = 0.460). Overall, nasal septal sutures significantly improve patient comfort during the postoperative period, when compared to nasal packing, with an earlier return to nasal respiration. The nasal septal chain suture that has been described in this study for the first time can be an alternative to nasal packing and the nasal septal suture techniques currently in use, since both absorbable and nonabsorbable materials can be used, it is easy to remove, and there is no pain during the suture removal.