A series of clinical cases of plastic closure of nasal septal perforations with a free trilayer graft

Objective. To evaluate the outcomes of using a free trilayer graft for nasal septal perforation repair. The graft consisted of a rigid support component (the perpendicular plate of the ethmoid bone or a resorbable polylactic acid plate) and costal perichondrium wrapped in temporoparietal fascia. Outcomes were assessed using subjective indicators, including the validated Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), and objective indicators, including operative time, paranasal sinuses computed tomography data, and the results of endoscopic examination of the nasal cavity before and after surgery.
Material and methods. A retrospective review of the medical records of 8 patients who underwent surgical repair of nasal septal perforations during the study period was performed. Subjective outcomes were assessed 3 months postoperatively using the validated Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). Objective assessment included endoscopic examination and computed tomography of the paranasal sinuses before surgery and 3 months after surgery.
Results. Nasal septal perforations were successfully closed using a free trilayer graft in all 8 patients. Patient age ranged from 28 to 35 years, with a mean age of 31.14 years. The perforations were located in the anterior and middle parts of the nasal septum. Their size ranged from 5 to 33 mm in the sagittal plane and from 5 to 20 mm in the vertical plane. Preoperative and postoperative SCHNOS-C and SCHNOS-O scores differed significantly (p=0.041, p=0.011, respectively), indicating improvement in nasal breathing and nasal aesthetics. The median SCHNOS-C score with interquartile range changed from 14.00 [5.75–17.75] to 1.00 [0.00–11.75]. The median SCHNOS-O score with interquartile range changed from 11,00 [7,25–12,75] до 2,00 [1,25–6,00]. The follow-up period ranged from 3 to 17 months.
Conclusion. In this clinical case series, the use of an interposition trilayer graft enabled restoration of nasal septal integrity in patients with septal perforation. Biodegradable implants and autologous tissues may be used to construct this graft. No revision procedures for perforation closure were required. This technique is straightforward, does not require intranasal flaps, is associated with a high perforation closure rate and improvement in patient symptoms, and does not result in significant complications. Prospective studies with larger patient cohorts are needed to further evaluate this method.
Keywords: nasal septum perforation, trilayer graft, temporoparietal fascia, costal perichondrium, rhinoplasty, septoplasty, polylactic acid, nanofat, mucosal regeneration, SCHNOS questionnaire, plastic surgery, nasal septum reconstruction, interposition graft, saddle nose deformity, case series
Conflict of interest. The authors declare no conflict of interest.
Financing. The work was completed without sponsorship.