External septal reconstruction with the use of polydioxanone foil: our experience

We present our experience and results after using polydioxanone (PDS) foil in septal reconstruction. In a period of 2 years, 12 patients who were admitted in our department with severe septal deviation and breathing problems underwent septoplasty under general anaesthesia. The nasal septum was approached via an external approach. In all patients, after resecting and exposing the septum, the removable piece after being divided into straight pieces, was sutured onto an appropriate sized PDS foil and reimplanted together between the mucoperichondrium flaps. Sutures were placed to fixate the "new septum" to the nasal dorsum and to the anterior nasal spine. The immediate postoperative course was unremarkable and in a follow-up appointment 6 months and 1 year postoperatively, one complication occurred, with septum subluxation noted in one patient. Use of PDS foil in septal reconstruction is an important surgical option for the correction of the markedly deviated nasal septum. Fixation of the straightened and replanted septum at the nasal dorsal septum border with the upper lateral cartilages and at the nasal spine is essential.

[Fibrin glue for operative correction of septal deviations]

The routine procedure after correction of septal deviations is the utilization of endonasal packing in order to avoid septal haematoma. However, the mechanical pressure of this packing damages the mucociliar activity of the mucosa and causes lymphoedema by blocking the lymphatic vessels. Besides it represents a foreign body within the nose causing pain and unpleasant feeling for the patient. In order to avoid these disadvantages, in 57 patients we used fibrin glue instead of nasal packing. After correction of the septal deviation the two mucoperichondrium blades where fixed together with Tissucol Duo Quick. This technique not only leads to haemostasis, but also provides fixation of the newly modeled septum. In only one patient we found a small unilateral septal haematoma, in all other cases the postoperative period showed no complications. Patients had a significant reduction of endonasal crusts and postoperative swelling. Patients comfort increased significant without the (standard) nasal packing.

Clinical and histological results of septoplasty with a resorbable implant

BACKGROUND

The use of a resorbable implant connected with septal cartilage would facilitate external septoplasty, offering mechanical stability until the cartilage fragments heal.

OBJECTIVE

To study the histological and clinical results of septoplasty with a resorbable implant (polydioxanone [PDS; Ethicon, Norderstedt, Germany]) in conjunction with cartilage.

DESIGN

To provide histological information in 5 rabbits, PDS foil was implanted into the outer ear in conjunction with an artificial cartilage defect. Observations were made at 2, 5, 10, 15, and 25 weeks. Resorption of the implant was investigated, including the time to complete elimination. In addition, septoplasty with PDS foil was performed on 71 patients with severe septal deformities. Surgery consisted of excision of the quadrilateral cartilage and division into straight fragments, which were sutured to the PDS foil and replaced as a free graft.

SETTING

Ear, nose, and throat department of the General District Hospital Steyr, Steyr, Austria.

RESULTS

Histological examination showed that the foil remained unchanged for at least 10 weeks and was completely resorbed after 25 weeks with minimal remaining scar tissue. Newly formed cartilage developed bordering the cartilage defect. In the clinical study, all patients experienced varying degrees of improvement in nasal blockage. No immediate or long-term complications occurred.

CONCLUSIONS

The use of PDS foil in connection with cartilage facilitates surgical correction of severe septal deformities, additionally providing support for the nasal dorsum. The histological examination showed that no inflammatory or foreign body reaction occurred. Cartilage regeneration was even found. The foil was completely resorbed within 25 weeks, avoiding the long-term complications that occur with other artificial implants.