Abstract
Objective
The aim of the study was to study a new treatment to repair large nasal septal perforation with medical titanium membrane.
Method
Ten patients with septal perforation underwent repair with open rhinoplasty approach using titanium membrane.
Results
The perforation of nasal septum in 10 patients was closed satisfactorily. During our follow-up period (mean, 1 year), the titanium membrane was mucosalized, and this technique led to persistent closing of perforation.
Conclusion
Repair of septal perforation with titanium membrane yields excellent results.
1
Introduction
Nasal septal perforation may be caused by trauma (including blunt, post surgery, and nose picking), inhaled irritant, neoplasm, inflammatory, and infectious disease . Patients with septal perforation have symptoms such as epistaxis, nasal obstruction, discharge, crusting, dryness, pain, and whistling .
Surgical closure of septal perforation is recognized as being particularly challenging. Numerous surgical techniques for the repair of this nasal defect have been described. The variety of techniques indicates that no single technique is recognized as being uniformally reliable in closing all perforations.
In this study, we present a new method using titanium membrane with open rhinoplasty approach to repair large septal perforation.
2
Surgical method
Under general anesthesia and with open rhinoplasty approach, first perforation was rimmed with a no. 12 blade to obtain fresh margins. Then bilateral mucoperichondrium was elevated completely. The nasal floor mucoperiosteum was elevated up to the inferior turbinate. After that, dorsal hump was removed extramucosally (if any) so as to provide excess mucosa. Then medical titanium membrane of adequate size was inserted between septum and left-sided mucoperichondrium ( Fig. 1 ). The titanium membrane used was 0.6 mm thick. It was perforated and bendable. We tried to close the mucosal defect primarily with 4-0 vicryl on titanium membrane. Therefore, we needed to dissect the mucoperichondrium extensively; it was elevated up to the inferior turbinate laterally. Hump removal also provided us with some excess mucosa. In 7 patients, the defect was closed primarily; in those patients in whom primary closure was not possible, we approximated the mucosal edges on the titanium membrane with quilting sutures of 4-0 vicryl so that mucosalization would occur and cover the titanium membrane. The titanium membrane was secured using quilting sutures ( Fig. 2 ).
The patients received systemic antibiotics for a week postoperatively. Anterior packing was removed on fifth postoperative day. The patients were instructed to keep the mucosa moist with nasal saline spray. The daily applications of antibiotic ointment may be helpful to further reduce the crusting during the healing process. Monthly examination of nasal septal mucosa was performed during follow-up.
2
Surgical method
Under general anesthesia and with open rhinoplasty approach, first perforation was rimmed with a no. 12 blade to obtain fresh margins. Then bilateral mucoperichondrium was elevated completely. The nasal floor mucoperiosteum was elevated up to the inferior turbinate. After that, dorsal hump was removed extramucosally (if any) so as to provide excess mucosa. Then medical titanium membrane of adequate size was inserted between septum and left-sided mucoperichondrium ( Fig. 1 ). The titanium membrane used was 0.6 mm thick. It was perforated and bendable. We tried to close the mucosal defect primarily with 4-0 vicryl on titanium membrane. Therefore, we needed to dissect the mucoperichondrium extensively; it was elevated up to the inferior turbinate laterally. Hump removal also provided us with some excess mucosa. In 7 patients, the defect was closed primarily; in those patients in whom primary closure was not possible, we approximated the mucosal edges on the titanium membrane with quilting sutures of 4-0 vicryl so that mucosalization would occur and cover the titanium membrane. The titanium membrane was secured using quilting sutures ( Fig. 2 ).
