[Closing of nasal septum perforation using adipose stromal vascular fraction: an experimental study]. / Zakrytie perforatsii peregorodki nosa s primeneniem stromal'no-vaskulyarnoi zhirovoi fraktsii: eksperimental'noe issledovanie.

Nasal septal perforation (NSP) is a complex problem in otorhinolaryngology, which leads to impaired nasal breathing and dryness in the nose. This reduces the patient's quality of life and leads to psychological discomfort. The treatment of nasal septum perforation is selected taking into account the clinical manifestations, perforation parameters and general condition of the patient. Currently, a large number of different surgical methods have been described in order to closing the defect of nasal septum. To date, there is no universally accepted method for closing NSP, which stimulates the search and development of new treatment options. OBJECTIVE: Under experimental conditions, to study a new method for closing nasal septum perforation using a collagen scaffold together with adipose stromal vascular fraction containing multipotent mesenchymal stromal cells. MATERIAL AND METHODS: The experiment was carried out on a model of nasal septum perforation in 24 male rabbits divided into four groups, depending on the construct, implanted into the defect zone: the 1st group was the control group - without the introduction of implantation material; the 2nd group - collagen scaffold without adipose stromal vascular fraction; the 3rd group - collagen scaffold with xenogenic adipose stromal vascular fraction; the 4th group - collagen scaffold with allogeneic adipose stromal vascular fraction with further dynamic evaluation of endoscopic control on day 14, after 1 month, 3 months, and 6 months. At month 6, the animals were removed from the experiment, followed by morphological examination in color with hematoxylin and eosin, as well as safranin and methyl green. RESULTS: As a result of the experiment using adipose stromal vascular fraction of allogeneic and xenogenic origin, closing of perforation of the nasal septum of a rabbit for 3 months of dynamic endoscopic control, as well as according to morphological research, was demonstrated. CONCLUSION: Our study showed that the use of adipose stromal vascular fraction containing not only endothelial cells and pericytes, but also multipotent mesenchymal stromal cells in combination with a collagen scaffold closes the perforation of the nasal septum in a rabbit, without increasing the risk of violations of habitual vital activity.

Nasal Septal Perforation and Widespread Skin Lesions Caused by Mycobacterium chelonae Infection Mimicking Granulomatosis with Polyangiitis.

Mycobacterium chelonae, a rapidly growing mycobacterium found in the natural environment, is known to cause localized lesions in the skin, soft tissue, and bone through traumatic inoculation, but widespread lesions are uncommon. We herein report an immunocompromised 79-year-old man suspected of having polyangiitis granulomatosis due to weight loss, epistaxis, and nasal crusts with impending septal perforation who was subsequently diagnosed with mucocutaneous and bone disease caused by widespread M. chelonae infection. Given these findings, clinicians should be aware of the tendency to develop unusual widespread lesions in immunocompromised patients, which can present a clinical picture similar to systemic vasculitides, such as granulomatosis with polyangiitis.

Factors Affecting the Surgical Outcome in Nasal Septal Perforation Repair.

OBJECTIVE: Nasal septal perforation (NSP) repair is challenging surgery considered in patients with symptomatic NSP intractable to conservative treatments. This study aimed to assess the success rate and identify factors affecting the surgical outcome of NSP by analyzing consecutive series of NSP repairs by a single surgeon. METHODS: We enrolled 84 patients diagnosed with NSP and who underwent surgical repair of NSP by a single surgeon (Y.J.J.) between November 2007 and July 2022. Medical records were retrospectively reviewed regarding variables involving preoperative symptoms, rhinologic history, etiology, surgical techniques, and the outcome of surgery. In addition, features of NSP were objectively evaluated using computed tomography scans. RESULTS: The overall success rate of NSP repair was 64.3% (54 of 84). Nasal obstruction (79.8%), crusting (34.5%), and epistaxis (27.4%) were frequent preoperative symptoms. Iatrogenic injury from previous nasal surgery (70.2%) was the most common cause. The average size of NSP on preoperative CT was 9.53 ± 6.68 mm. Patients with incomplete NSP closure had significantly larger perforations (12.21 ± 7.92 mm) than those with successful closure (8.04 ± 5.41 mm) preoperatively (P = .005). Patients with smoking history (OR = 2.971, 95% CI 1.170-7.548, P = .020) and NSP repair with combined rhinoplasty (OR = 3.811, 95% CI 1.401-10.370, P = .007) were more likely to experience incomplete closure. Patients whose perforations were reinforced with interposition graft were more likely to result in successful repair (OR = 6.752, 95% CI 2.496-18.262, P < .001). The bilaterality of mucosal flap coverage, surgical approach, types of mucosal flap and interposition graft, perforation shape, mucosal thickness around perforation, and distance from the nasal floor were not significantly related to the surgical outcome. CONCLUSIONS: Significant factors affecting the outcome of NSP repair were patient's smoking status, combined rhinoplasty, application of interposition graft, and perforation size.

B-cell Lymphoma Presenting as Nasal Septal Perforation.

Sinonasal lymphoma is a rare clinical entity. Three main subtypes exhibit different clinical patterns and treatment outcomes. We report the first case of a B-cell lymphoma in a patient without any previous history of nasal surgery, trauma or drug use, who presented to our center with a nasal septal perforation. Laryngoscope, 133:2871-2873, 2023.

Nasal Septal Perforation Secondary to Graft-Versus-Host Disease.

Nasal septal perforation is a full-thickness defect of the nasal septum. There are many described etiologies of nasal septal perforation, including trauma, infectious, neoplastic, iatrogenic, and autoimmune. Graft-versus-host disease (GVHD) is a common and potentially life-threatening complication that can occur after an allogenic transplant. GVHD can result in the development of autoantibodies that lead to granulomatous inflammation with necrotizing vasculitis, causing perforation of the nasal septum. In this report, we describe a patient with nasal septal perforation secondary to GVHD and hope to provide novel insights into the association of GVHD and nasal septal perforation.

Repair of Septal Perforations.

Nasal septal perforations have varied etiologies, clinical presentations, and methods of management. Some patients may be asymptomatic, while others may complain of nasal obstruction, crusting, epistaxis, and whistling. Management of nasal septal perforations is guided by the patient's symptoms and characteristics of the perforation. Some lesions can be managed conservatively or with minimally invasive procedures, while others require surgery. Surgical repair of perforations can be challenging and many techniques have been described without a standardized method of management. This article aims to provide a comprehensive review of options for repair of nasal septal perforations.

Unusual Complication of Nasal Irrigation: Three Case Reports of Nasal Septal Perforation.

The usefulness of nasal irrigation for chronic rhinosinusitis is recognized, and it is widely used as a topical treatment after endoscopic sinus surgery (ESS). Generally, there are few complications due to nasal irrigation, and it is recognized as a highly safe treatment. There are no reports of nasal septal perforation due to nasal irrigation. The objective of this study was to describe three cases of nasal septal perforation occurring during self-nasal irrigation after ESS. Case patient 1 was a 38-year-old woman who was admitted to our hospital with a complaint of nasal obstruction. Based on a diagnosis of chronic rhinosinusitis and allergic rhinitis, we performed bilateral ESS and bilateral inferior turbinectomy. At discharge, we instructed the patient in how to perform self-nasal irrigation twice a day at home. At the time of the third visit after discharge, a black crust had adhered to the bilateral anterior nasal septum. Crust formation continued at the same site, and nasal septal perforation was seen two and a half months after the operation. The other two cases showed similar courses. Postoperative nasal irrigation can cause nasal septal perforation. We need to educate patients on proper nasal irrigation and regularly check the nasal septum.

Innovative Surgical Techniques for Nasal Septal Perforations: Management and Treatment.

PURPOSE OF REVIEW: The aim of this study was to review and describe the main innovative surgical techniques for nasal septal perforation (NSP) repair that have been published in recent years. RECENT FINDINGS: Several techniques for NSP repair have been developed recently. The anterior ethmoidal artery (AEA) flap is a versatile technique for middle-size perforations in different locations. The greater palatine artery (GPA) flap is an excellent option for anterior-most NSPs. The lateral nasal wall flap and the pericranial flap are the most appropriate techniques for large perforations. The advent of these techniques has changed the management and has expanded the therapeutic arsenal to treat all types of NSPs according to the size, location, and osteo-cartilaginous support. However, no technique has been accepted as the gold standard. Extensive knowledge of different techniques is important to individualize the treatment, selecting the most appropriate in each case.

Outcomes of Septal Perforation Repair With Concurrent Endoscopic Sinus Surgery.

OBJECTIVE: This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported. STUDY DESIGN: Case series. SETTING: Tertiary care center. METHODS: In this institutional review board-approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up. RESULTS: Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs. CONCLUSION: Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.

Granulomatosis with polyangiitis presenting with unilateral facial nerve palsy and nasal septum perforation.

Granulomatosis with polyangiitis (GPA) is a necrotising vasculitis of unknown cause that has several systemic manifestations. The disease is characterised by the classical triad involving acute inflammation of the upper and lower respiratory tracts with renal involvement. However, the disease pathology can involve the central nervous system. This case report presents a case of GPA with facial nerve palsy as the first manifestation of the disease, which has been rarely reported in the medical literature.

Septal Perforation Repair Using Bilateral Rotational Flaps With Interposed Mastoid Periosteal Graft.

OBJECTIVES/HYPOTHESIS: To evaluate the outcomes of endonasal repair of septal perforations utilizing opposing bilateral rotational flaps and a periosteum interposition graft. METHODS: Retrospective review of a single surgeon, tertiary referral center experience of patients who underwent septal perforation repair. Patient demographics, etiology of perforation, closure rate, and complication data were obtained. Patients screening positively for cocaine use or anti-neutrophil cytoplasmic antibodies (ANCA) were not offered repair. RESULTS: A total of 104 patients were included, 65 male and 39 female with mean age of 45.4 years. Etiology of perforations included prior surgery in 45, trauma in 15, and unknown in 44, and the average perforation size in each etiologic group were 1.35 cm, 1.25 cm, and 1.30 cm, respectively. The greatest dimension of perforations repaired ranged from 0.5 cm to 1.5 cm. The overall success rate was 87.5% at 6 month follow-up. Successful closure was achieved in 95.6%, 86.7%, and 79.5%, respectively (χ2  = 5.264, P = .0218). CONCLUSION: Our described technique is a reliable endonasal approach with predictable outcomes in septal perforations up to 1.5 cm in size. Having an unknown etiology of septal perforation may be a risk factor for failure. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1497-1500, 2021.

Cocaïne et lésions destructrices centro-faciales : à propos d'un cas.

INTRODUCTION: Cocaine use is associated with multiple complications, some of which can mimic systemic diseases, especially Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis. We report a case of Cocaine Induced Midline Destructive Lesions (CIMDL) for which a diagnosis of granulomatosis with polyangiitis (GPA) was discussed. CASE REPORT: A 42-year-old male, cocaine consumer, was admitted in our department for a centrofacial destructive process. He had no extra ear, nose and throat (ENT) involvement. ANCA were positive with a perinuclear fluorescence pattern and an anti-Proteinase 3 specificity. Regarding this unusual immunologic pattern and in the absence of histological argument for a GPA, a diagnosis of CIMDL was made. CONCLUSION: CIMDL is a centrofacial destructive process due to intranasal cocaine use. It is frequently associated with the presence of p-ANCA with both anti-HNE and anti-PR3 specificity.

Case Report: Successful Treatment with Miltefosine of Severe New World Mucosal Leishmaniasis Caused by Leishmania guyanensis.

An 88-year-old man with mutilating mucosal leishmaniasis (ML) involving septal perforation, with granulomas in the pharynx and larynx, was treated with oral miltefosine, 50 mg three times/day for 28 days. Miltefosine, an antineoplastic agent, is considered an alternative option for the treatment of ML, showing efficacies of 75-92% in Bolivia, Brazil, and Argentina. The patient denied having previous cutaneous (CL) leishmaniasis, and no CL lesions were recognized by physical examination. Parasites obtained from mucosal lesions were identified by cytochrome b gene sequencing as Leishmania guyanensis. Clinical cure was observed 2 months posttreatment, and no evidence of reactivation was observed in the 3-year follow-up. Adverse effects such as nausea, loss of appetite, and epigastric pain were experienced during treatment with miltefosine. There is a need for improved access to miltefosine in leishmaniasis-endemic areas of Latin America and a greater awareness of ML and its treatment among physicians working in endemic countries.

Approach to Correction of Septal Perforation.

Iatrogenic septal perforation is a complication of nasal surgery. Small or posterior perforations cause few symptoms, and need only conservative treatment. Larger and anterior perforations contribute to nasal airflow disturbances and external nasal deformities. When considering surgical candidacy, one should consider the severity of symptoms, location and size of the perforation, and need for revsional rhinoplasty. We repair perforations using intranasal mucosal advancement flaps augmented by an interposition connective tissue graft. Septal perforation repairs are tedious and technically challenging. We review key points to minimize unintended perforation formation following nasal surgery.

Rheumatoid Arthritis Complicated with Nasal Septum Perforation Due to Methotrexate-associated Lymphoproliferative Disorder.

A 44-year-old female with rheumatoid arthritis treated with methotrexate (MTX) and tocilizumab (TCZ) was admitted to our hospital with nasal pain. Nasal fiberscopy revealed septum perforation, while a membrane biopsy indicated granuloma and fibrinoid necrosis of the small artery. The patient was treated with prednisolone 30 mg/day after discontinuation of MTX and TCZ. Inguinal lymph node biopsy revealed diffuse infiltrations of atypical T-cells and Epstein-Barr virus-positive B cells. The patient was diagnosed with peripheral T-cell lymphoma due to MTX-associated lymphoproliferative disorder (MTX-LPD). We herein describe the case of a patient with nasal septum perforation due to MTX-LPD mimicking granulomatosis with polyangiitis.

Posteroinferior septal defect due to vomeral malformation.

PURPOSE: Vomeral malformation may lead to a posteroinferior septal defect (PISD). It is usually found incidentally, without any characteristic symptoms. The purpose of this study was to evaluate its clinical implications. METHODS: In this study, we included 18 patients with PISD after reviewing paranasal sinus computed tomography scans and medical records of 2655 patients. We evaluated the shape of the hard palate and measured the distances between the anterior nasal spine (A), the posterior end of the hard palate (P), the posterior point of the vomer fused with the palate (V), the lowest margin of the vomer at P (H), and the apex of the V-notch (N). RESULTS: None of the PISD patients had a normal posterior nasal spine (PNS). Six patients lacked a PNS or had a mild depression (type 1 palate), and 12 had a V-notch (type 2 palate). The mean A-P, P-H, and P-V distances were 44.5 mm, 15.3 mm, and 12.4 mm, respectively. The average P-N distance in patients with type 2 palate was 7.3 mm. There were no statistically significant differences between the types of palates in A-P, P-H, or P-V distances. In patients with type 2 palate, there was a significant correlation between P-V and P-N distances (r = 0.664, p = 0.019). CONCLUSIONS: PISD due to vomeral malformations was identified in 0.7% of the cases in this study. None of the subjects had a normal PNS, which suggests that the development of the vomer is closely related to that of the hard palate.

Intracorporeal Septorhinoplasty: Technique and Outcome.

OBJECTIVE: Septal deformities usually associated with functional and aesthetic nasal consequences. Multiple techniques were described to correct these deformities. Using less invasive and at the same time competent technique with loge standing results is important. This study aimed to assess intracorporeal correction for septal deviation with assessment of its competence in managing deferent degrees of deviation and to show concomitant patient-dependant internal valve manipulation used. METHODS: Intracorporeal correction of septal deviation was used in 35 patients which was performed at plastic surgery departments of Menoufia University Hospital and Mawada Privet Hospital, Egypt. The study was carried out between July 2014 and July 2017. RESULTS: Thirty-five patients with variable types of septal deformities, 16 of them were females and 19 were males, were included in the study. Age of patients was between 18 and 55 years (mean 24.9, standard deviation 7.9). Etiology was found as follows: 15 (about 43%) posttraumatic septal deviation, 8 (about 23%) patients had postcleft septal deviation, and the remaining 12 had idiopathic septal deviation. Spreader graft was in 22 (about 63%) patients. Septal hematoma followed by septal perforation occurred in 1 patient (2.8%), while dorsal irregularities were found in 3 (8.4%) patients. Recurrent septal deviation occurred in 2 (5.6%) patients. Concerning functional outcome, no residual nasal obstruction was found in all patients with negative Cottle sign postoperative. CONCLUSION: Intracorporeal correction of septal deformities in open rhinoplasty technique is still found to be effective and less invasive option even with sever septal deviation.

A CFD approach to understand nasoseptal perforations.

INTRODUCTION: Nasoseptal perforations (NSP) are becoming common in the modern world, and can cause a wide variety of symptoms, including a sensation of nasal obstruction, epistaxis, crusting, dryness, headache, nasal pain and a whistling sound. There is an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. The lack of consistent surgical results may be related to the lack of knowledge about the pathophysiology of NSP and how they affect the nasal flow. Computational fluid dynamics (CFD) has proved to be a very useful tool to study nasal function. METHODS: We have used CFD software (the program MECOMLAND® and the Digbody® tool for virtual surgery) to investigate the behaviour of the parameters R-[Formula: see text] based on CFD results, when four subjects underwent virtual surgery to induce a septal perforation: two subjects with healthy noses and two patients suffering from nasal airway obstruction. For each case a CFD study was performed, before and after creating an anterior (close to nostrils) or a posterior (close to choanae) NSP. RESULTS: In all cases analyzed, a posterior septal perforation did not result in a significant volumetric flow rate [Formula: see text] through the perforation between nasal passages. However, for anterior defects only in those nasal cavities considered diseased or unhealthy, high values of [Formula: see text] were found. CONCLUSION: The induced NSP only rendered significant flow alterations in noses with preexisting nasal airway obstruction alterations, whereas in nasal cavities considered as normal the creation of a NSP did not produce significant differences between both sides. We strongly suggest that this finding can explain the variety of symptoms and the number of asymptomatic patients bearing NSP.

Correcting the Cleft Lip Nose Deformity: The Graft Number 1 for the Columella.

BACKGROUND: The nose deformity associated with cleft lip is difficult to solve in the primary and secondary surgery. In an adult patient, many techniques are used including mobilization, suspension, fixation and trimming the alar cartilages, septoplasty, nasal bones osteotomies, and dorsal bone and cartilage resection. Different types of cartilage grafts are commonly used. METHODS: A septal cartilage graft was used in 75 adult patients with mild to severe cleft lip deformities. Based on the golden ratio proportions of the columella that can be observed in the lateral view, a septal cartilage graft with a number 1 shape was created and inserted between the medial cruras in 75 patients, with unilateral or bilateral cleft lip, between 2007 and 2014. Complementary surgery was done in the nose of all the patients. A retrospective, observational, and descriptive study was made with presurgical and postsurgical photographs, throughout a 6-month follow-up period. RESULTS: Excellent cosmetic and functional results were seen, especially in the lateral view. There was 1 septal perforation reported. The patients were satisfied with the aesthetic results. CONCLUSION: The graft number 1 works in the reality; it has proven to be a stable support to the affected cartilage, projects a nice nasal tip, and is a lasting solution for adults.