Document Type : Original Article

Authors

1 Dept. of Oral and Maxillofacial Surgery, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Dept. of Orthodontics, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Statement of the Problem: The surgical repair of nasal septal perforation (NSP) has always been a challenging procedure and no consensus has been made about a definitive protocol.
Purpose: In the current study, we investigated the use of cryopreserved amniotic membrane with mucosal rotational flap for the surgical repair of NSPs.
Materials and Method: In this prospective clinical study, 12 patients with symptomatic NSP underwent primary surgical repair, between December 2018 and October 2019. The surgical procedure comprised of a rotational flap on one side of the defect and cryopreserved amniotic membrane as an interpositional graft in the mucoperichondrial pocket on the other side. The patency of defect was checked at a follow-up appointment at least 3 months after surgery.
Results: Successful repair was perceived in 10 of 12 (83%) of patients. Reperforation occurred in two patients but the size of the defect was smaller than the original one. All of the patients reported elimination of all symptoms associated with NSP.
Conclusion: The use of cryopreserved amniotic membrane as an interpositional graft accompanied by a mucosal rotational flap seems to be efficient in alleviating the symptoms of NSP and closure of the defect.

Keywords

  • Oberg D, Akerlund A, Johansson L, Bende M. Prevalence of nasal septal perforation: the Skovde population-based study. Rhinology. 2003; 41: 72-75.
  • Tasca I, Compadretti GC. Closure of nasal septal perforation via endonasal approach. Otolaryngol Head Neck Surg. 2006; 135: 922-927.
  • Daneshi A, Mohammadi S, Javadi M, Hassannia F. Repair of large nasal septal perforation with titanium membrane:: report of 10 cases. Am J Otolaryngol. 2010; 31: 387-389.
  • Heller JB, Gabbay JS, Trussler A, Heller MM, Bradley JP. Repair of large nasal septal perforations using facial artery musculomucosal (FAMM) flap. Ann Plast Surg. 2005; 55: 456-459.
  • André R, Lohuis P, Vuyk H. Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines. J Plast Reconstr Aesthet Surg. 2006; 59: 829-834.
  • Kobus KF. Cleft palate repair with the use of osmotic expanders: a preliminary report. J Plast Reconstr Aesthet Surg. 2007; 60: 414-421.
  • Ayshford C, Shykhon M, Uppal H, Wake M. Endoscopic repair of nasal septal perforation with acellular human dermal allograft and an inferior turbinate flap. Clin Otolaryngol. 2003; 28: 29-33.
  • Parry JR, Minton TJ, Suryadevara AC, Halliday D. The use of fibrin glue for fixation of acellular human dermal allograft in septal perforation repair. Am J Otolaryngol. 2008; 29: 417-422.
  • Dua HS, Gomes JA, King AJ, Maharajan VS. The amniotic membrane in ophthalmology. Surv Ophthalmol. 2004; 49: 51-77.
  • Kesting MR, Wolff KD, Nobis CP, Rohleder NH. Amniotic membrane in oral and maxillofacial surgery. Oral Maxillofac Surg. 2014; 18: 153-164.
  • Özkaya Ö, Egemen O, Yeşilada A, Sakız D, Ugurlu K. The effect of nonpreserved human amniotic membrane on the survival of ischaemic skin flaps in rats. J Plast Reconstr Aesthet Surg. 2012; 65: 1700-1705.
  • Güler R, Ercan M, Ulutuncel N, Devrim H, Uran N. Measurement of blood flow by the 133Xe clearance technique to grafts of amnion used in vestibuloplasty. Br J Oral Maxillofac Surg. 1997; 35: 280-283.
  • Samandari MH, Yaghmaei M, Ejlali M, Moshref M, Saffar AS. Use of amnion as a graft material in vestibuloplasty: a preliminary report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97: 574-578.
  • Velez I, Parker WB, Siegel MA, Hernandez M. Cryopreserved amniotic membrane for modulation of periodontal soft tissue healing: a pilot study. J Periodontol. 2010; 81: 1797-1804.
  • Kesting MR, Loeffelbein DJ, Classen M, Slotta-Huspenina J, Hasler RJ, Jacobsen F, et al. Repair of oronasal fistulas with human amniotic membrane in minipigs. Br J Oral Maxillofac Surg. 2010; 48: 131-135.
  • Laurian N, Kalmanovitch M, Shimberg R. Amniotic graft in the management of severe epistaxis due to hereditary haemorrhagic telangiectasia. J Laryngol Otol. 1979; 93: 589-595.
  • Tuncel U, Ozgenel G. Use of human amniotic membrane as an interpositional material in treatment of temporomandibular joint ankylosis. J Oral Maxillofac Surg. 2011; 69: e58-e66.
  • Rinastiti M, Santoso A, Sosroseno W. Histological evaluation of rabbit gingival wound healing transplanted with human amniotic membrane. Int J Oral Maxillofac Surg. 2006; 35: 247-251.
  • Rohleder NH, Loeffelbein DJ, Feistl W, Eddicks M, Wolff KD, Gulati A, et al. Repair of oronasal fistulae by interposition of multilayered amniotic membrane allograft. Plast Reconstr Surg. 2013; 132: 172-181.
  • Chhabra N, Houser SM, editors. Endonasal repair of septal perforations using a rotational mucosal flap and acellular dermal interposition graft. Int Forum Allergy Rhinol; 2012: Wiley Online Library.
  • Lee HR, Ahn DB, Park JH, Kim YH, Sin CM, Youn SJ, et al. Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap. Clin Exp Otorhinolaryngol. 2008; 1:
  • Watson D, Barkdull G. Surgical management of the sept-al perforation. Otolaryngol Clin North Am. 2009; 42: 483-493.
  • Re M, Paolucci L, Romeo R, Mallardi V. Surgical treatment of nasal septal perforations. Our experience. Acta Otorhinolaryngol Ital. 2006; 26: 102.
  • Goh A, Hussain S. Different surgical treatments for nasal septal perforation and their outcomes. J Laryngol Otol. 2007; 121:419-426.
  • Kridel RW, Appling WD, Wright WK. Septal perforation closure utilizing the external septorhinoplasty approach. Arch Otolaryngol Head Neck Surg. 1986;112:168-172.
  • Fairbanks D, Fairbanks GR. Nasal septal perforation: prevention and management. Ann Plast Surg. 1980; 5: 452-459.
  • Murakami CS, Kriet JD, Ierokomos AP. Nasal reconstruction using the inferior turbinate mucosal flap. Arch Facial Plast Surg. 1999;1:97-100.
  • Romo T, Foster CA, Korovin GS, Sachs ME. Repair of nasal septal perforation utilizing the midface degloving technique. Arch Otolaryngol Head Neck Surg. 1988;114:739-742.
  • Teichgraeber JF, Russo RC. The management of septal perforations. Plast Reconstr Surg. 1993; 91: 229-235.
  • Vuyk H, Versluis R. The inferior turbinate flap for closure of septal perforations. Clin Otolaryngol. 1988;13:53-57.
  • Murrell GL, Karakla DW, Messa A. Free flap repair of septal perforation. Plast Reconstr Surg. 1998; 102: 818-821.
  • Belmont JR. An approach to large nasoseptal perforations and attendant deformity. Arch Otolaryngol. 1985; 111: 450-455.
  • Romo T, Jablonski RD, Shapiro AL, McCormick SA. Long-term nasal mucosal tissue expansion use in repair of large nasoseptal perforations. Arch Otolaryngol Head Neck Surg. 1995;121:327-331.
  • Ohlsén L. Closure of nasal septal perforation with a cutaneous flap and a perichondrocutaneous graft. Ann Plast Surg. 1988; 21: 276-288.
  • Kridel RW, Foda H, Lunde KC. Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg. 1998;124:73-8.
  • Romo T, Sclafani AP, Falk AN, Toffel PH. A graduated approach to the repair of nasal septal perforati-ons. Plast Reconstr Surg. 1999; 103: 66-75.
  • Kothari CR, Goudar G, Hallur N, Sikkerimath B, Gudi S, Kothari MC. Use of amnion as a graft material in vestibuloplasty: a clinical study. Br J Oral Maxillofac Surg. 2012; 50: 545-549.
  • Rehan M, Khatri M, Bansal M, Puri K, Kumar A. Comparative Evaluation of Coronally Advanced Flap Using Amniotic Membrane and Platelet-rich Fibrin Membrane in Gingival Recession: An 18-Month Clinical Study. Contemp Clin Dent. 2018; 9: 188.
  • Delaney SW, Kridel RW. Contemporary trends in the su-rgical management of nasal septal perforations: a community survey. Facial Plast Surg. 2019; 35:78-84.