Multicenter Pilot Study to Assess a Biphasic Calcium Phosphate Implant for Functional and Aesthetic Septorhinoplasty

Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis

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.

Functional assessment of septo(rhino)plasty revision surgery

INTRODUCTION

Functional septo(rhino)plasty incurs a 17-25% rate of revision for persistent symptoms.

OBJECTIVES

The main study objective was to assess functional results before and after surgical revision. The secondary objective was to describe the shortcomings or excesses of the prior surgeries, with a-posteriori comparison of efficacy for the surgical techniques requiring revision.

MATERIAL AND METHODS

A single-center retrospective study included functional salvage septo(rhino)plasties. Data comprised epidemiology, intraoperative anatomic abnormalities indicative of prior surgery, operative correction maneuvers, and pre- and post-intervention NOSE and RhinoQoL scores and satisfaction on VAS.

RESULTS

Eighty-two patients were included. Anatomic abnormalities comprised deviated posterior septum (81.7%) and chondroethmoidal junction (58.5%), valve stenosis (54.9%), and obstructive boney spur or crest (46.3%). Prior surgeries comprised 33 submucosal resections, 29 septorhinoplasties, 14 Cottle septoplasties and 5 Killian procedures. Complete septoplasty was performed in 80% of cases, with associated maneuvers in 15%. All scores showed improvement taking the whole population together (P<10-5), but on subgroup analysis improvement concerned only revision of septorhinoplasty (P<10-4) and of submucosal resection (P<10-3), while 17% of patients showed no change in scores.

CONCLUSION

Functional nasoseptal salvage surgery enables most patients to recover respiratory comfort, with the exception of a few cases despite a perfectly straight nasal septum.

EFFECT OF AUTOGENOUS BONE GRAFT SITE ON DENTAL IMPLANT SURVIVAL AND DONOR SITE COMPLICATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVES

This systematic review and meta-analysis was undertaken to answer the following focus questions: Is the implant survival in augmented bone utilizing iliac crest bone grafts the same as while using intraoral autologous bone grafts? Is the incidence of postoperative donor site complications the same when using iliac crest bone grafts as opposed to intraoral grafts?

METHODS

Systematic searches of electronic databases (PubMed, Embase, CENTRAL) were performed to identify studies which reported on implant survival and postoperative complications for dental implants placed in grafted partially/completely edentulous human jaws. Studies were included if: they reported on 2-piece micro-rough surface root form dental implants placed in bone-augmented completely or partially edentulous human jaws, and the jaws must have been augmented with autologous bone graft materials. Time and nature of postoperative complications must have been reported. Two investigators performed data extraction and a Cohen's unweighted kappa was calculated for inter-investigator reliability. A meta-analysis was performed for the extracted data on implant survival rate in both iliac crest grafts and intra-oral grafts. A qualitative analysis was performed on the information extracted on graft donor site complications. Quality assessment of the included studies were done using the Cochrane collaboration tool and the Newcastle-Ottawa scales.

RESULTS

A total of 23 studies were included in the final analysis. The calculated kappa ranged between 0.77-0.89 for the literature search and identification process. Fourteen studies were included with data on implant survival including five randomized controlled clinical trials. The meta-analysis of included studies revealed that the implant survival rate of dental implants placed in jaws augmented with iliac crest grafts was lower than those placed in jaws augmented with intra-oral bone grafts at 6-months [ICG = 95.8% IOG = 98.4%; P < .001], 12-months [ICG = 97.0%, IOG = 98.4%; P < .001], 24-months [ICG = 85.9%, IOG = 98.2%; P < .001], 60-months [ICG = 90.0%, IOG = 91.5%; P < .001], and at 120-months [ICG = 88.8%, IOG = 95.2%; P < .001] follow-up periods. Iliac crest grafts were also frequently associated with donor site complications including pain / discomfort, gait disturbance, and sensory disturbance.

CONCLUSIONS

This systematic review and meta-analysis demonstrates that implant survival is consistently higher in bone harvested from intraoral sites compared to iliac crest grafts. Donor site complications seemed to be a frequent finding with iliac crest grafts and mental grafts.

FUNDING

None.

REGISTRATION

The review protocol was registered with PROSPERO: International prospective register of systematic reviews (CRD42021283738).