J Rhinol.  2021 Nov;28(3):158-163. 10.18787/jr.2021.00378.

Prevention of Septal Perforation Using a Combination of Crushed Cartilage and Thin Silastic Sheet During Septoplasty

• Kim YG
• Kim SJ
• Bae WY

• KMID: 2522785
• DOI: http://doi.org/10.18787/jr.2021.00378

Abstract

Background and Objectives
The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty.
Materials and Methods
A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed.
Results
Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications.
Conclusion
This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.

Keyword

Nasal septum perforation; Septoplasty; Silastic; Crushed cartilage

Figure

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  Fig. 1. Cartilage crusher and cartilage crushing. A: Autologous cartilage before crushing (length: 1 cm). B: Autologous cartilage before crushing (width: 1.5 cm). C: Cartilage crusher (Karl Storz Germany-5239; Karl Storz, Walsdorf, Germany). D: Autologous cartilage after crushing (length: 1.5 cm). E: Autologous cartilage after crushing (width: 2 cm).

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  Fig. 2. Intraoperative finding. A, B: Both septal mucosal was perforated. C: The crushed septal cartilage was inserted between the perforated mucosa. D, E: Thin silastic sheet (0.254 mm; Non-Reinforced Sheeting, Bioflexus, Kingman, AZ, USA) was covered on both perforated septal mucosa.

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  Fig. 3. Representative case where both septal mucosa well healed. A: Right nasal cavity. B: Left nasal cavity.

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  Fig. 4. Schematic diagram. S, septal cartilage; M, septal mucosa; CC, crushed cartilage; SS, silastic sheet (0.254 mm thickness; NonReinforced Sheeting, Bioflexus, Kingman, AZ, USA); TSS, thick silastic sheet (1 mm thickness; Internal Nasal Splint, MEDTRONIC, Minneapolis, MN, USA).

Reference

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