• Archives of Craniofacial Surgery
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• v.25 no.5
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• pp.247-251
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• 2024

Septal perforation is an anatomical defect of the nasal septum that leads to impaired nasal function, including obstruction and respiratory issues. In this study, a novel surgical approach was introduced to address septal perforations, focusing on the use of costal composite chondro-perichondrial grafts bilaterally in a symmetric manner. This composite graft, composed of costal cartilage and perichondrium, provides mechanical support, aids vascularization, and minimizes perichondrial shrinkage. A case study of a 23-year-old patient with septal perforation resulting from multiple rhinoplasty procedures is presented. The surgical procedure involved the use of a composite graft to close the septal perforation and correct the nasal deformity. The postoperative results demonstrated successful septal perforation closure and relief from nasal discomfort. This study highlights the advantages of this method, particularly its simplicity and straightforward surgical procedures for closing septal perforations of various sizes, and its suitability for rhinoplasty surgeons who are familiar with costal cartilage harvesting.

• Archives of Plastic Surgery
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• v.41 no.4
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• pp.403-406
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• 2014

Background Perforations in the nasal septum (NSP) give rise not only to disintegration of the septum anatomy but also impairment in normal nasal physiology. The successes of these surgical techniques are usually equated to anatomical closure of the perforation. The goal of this study is to evaluate the subjective and objective results of our surgical technique for septal perforation surgery. Methods All NSPs in the six patients were closed by inferior turbinate flap. The Nasal Obstruction Symptom Evaluation (NOSE) instrument was used to evaluate the preoperative and postoperative subjective sensation of nasal obstruction. Measurement of preoperative and postoperative nasal airway resistance was performed using active anterior rhinomanometry which is an objective test. Wilcoxson signed rank test and Spearman correlation test were used to analyze correlation between NOSE scores and rhinomanometric measurements. Results The full closure of the septal perforations was noted in 100% of patients. The total NOSE score was 14 preoperatively and one postoperatively. The improvement in NOSE scores was statistically significant ($P{\leq}0.002$). The mean preoperative total resistance (ResT150) value was $0.13Pa/cm^3s^{-1}$, which is below the normal range ($0.16-0.31Pa/cm^3s^{-1}$), while the mean postoperative ResT150 value was $0.27Pa/cm^3s^{-1}$. The correlation between the improvement in NOSE scores and improvements in ResT150 values was statistically significant. Conclusions Surgical approaches should aim to solve both the anatomical and physiological problems of NSP. The application of subjective and objective tests in the postoperative period will help surgeons assess the applied techniques.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.561-564
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• 2012

Nasal bone fractures are often accompanied by septal fractures or deformity. Posttraumatic nasal deformity is usually caused by septal fractures. Submucosal resection and septoplasty are commonly used surgical techniques for the correction of septal deviation. However, septal perforation or saddle nose deformity is a known complication of submucosal resection. Hence, we chose to perform septoplasty, which is a less invasive procedure, as the primary treatment for nasal bone fractures accompanied by septal fractures. During septoplasty, we used a bioabsorbable mesh as an internal splint. We used the endonasal approach and inserted the mesh bilaterally between the mucoperichondrial flap and the septal cartilage. The treatment outcomes were evaluated by computed tomography (CT) and the nasal obstruction symptom evaluation (NOSE) scale. The CT scans demonstrated a significant improvement in the septal deviation postoperatively. The symptomatic improvement rated by the NOSE scale was greater at 1 month and 6 months after surgery compared to the preoperative status. There were no cases of extrusion or infection of the implant. In cases of moderate or severe septal deviation without dislocation from the vomerine groove on the CT scan, our technique should be considered one of the treatments of choice.

• Journal of Preventive Medicine and Public Health
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• v.28 no.3 s.51
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• pp.678-689
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• 1995

Chromium is one of the representative toxic substance by occupational exposure which damage the mucosa of respiratory tract including nasal septal perforation. The aim of this study is to evaluate the effect of chromium exposure on olfactory function and to obtain the fundamental information about chromium exposure. The authors performed olfactory function test, laboratory tests and questionnaire interview on the subject of three groups, that is, two exposed groups and one nonexposed group from May 1 to June 30, 1994. Exposed group 1 was 15 male workers without nasal septal perforation, exposed group 2 was 15 male workers with nasal septal perforation among 103 workers in 22 chromium plating factories, and nonexposed group was 15 male medical students. The gathered informations were histories of chromium exposure, habits of smoking and alcohol drinking, the concentrations of chromium in serum and urine, and asparate aminotransferase(AST), alanine aminotransferase(ALT), gamma-glutamyl transferase, etc. Olfactory function was checked by T and T olfectometer using phenyl ethyl alcohol(material A), methyl cyclopentenolone(material B), iso-valeric acid(material C), $\gamma$-undecalactone(material D), skatole(material E) and the results were expressed by detection threshold(DT) and recognition threshold(RT). There was a significant difference between exposed groups and nonexposed group in A, B, C, D, E substances by DT and in A, B, C, D substances by RT(P<0.01). The degree of olfactory dysfunction was highest in the exposed group 2 and lowest in the nonexposed group in all five substances by DT and it was same in A B, D substances RT and the difference of RT and DT. As summary, olfactory dysfunction by chromium exposure was recognized and the degree of olfactory dysfunction was higher in the exposed group with nasal septal perforation. Therefore, it would be helpful to apply olfactory function test for the early detection of olfactory dysfunction, and this test would be considered as the basic tool within workers' compensation system.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.43-48
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• 2005

Septal deviations interfere with the nasal airflow and contribute to the deformities in the external appearance of the nose. An aesthetically and functionally satisfactory correction of severe septal deformities often requires temporary intraoperative removal of the septal cartilage for appropriate remodeling. This article describes septoplasty through dorsal approach for the correction of septal deviation. From March 2001 to April 2004, the author performed septoplasty through dorsal approach for the correction of septal deviations on 45 patients, of whom 22 of whom had nasal obstruction. Open rhinoplasty was used for dorsal approach in all patients and operation was performed under the general anesthesia or local anesthesia. The follow-up period of the patients ranged from 3 to 15 months with a mean of 10 months, and postoperative results were quite satisfactory. There was neither incidences of patients' complaints, nor any complications such as hematoma, septal perforation, supratip deformity, or recurrence. And there was some improvement of nasal obstruction in 15 patients. In conclusion, Septoplasty through dorsal approach is an effective method for the correction of septal deviation and improvement of the nasal airway obstruction.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.589-596
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• 2008

Purpose: The nasal bone fracture is most common fracture in facial bone injuries. Regardless of the severity or type of fracture, closed reduction has traditionally been the common method of treatment. However, through detailed pre-operative evaluation, we found out that many patients consider rhinoplasty prior to trauma due to aesthetic desire or nasal deformity with or without septal deviation. In treatment of nasal bone fracture, we focused not only on the fracture management but also on the patients' desire prior to trauma, and we made additional operation according to patients' desire with fracture reduction and gained rewarding outcomes. Methods: From March 2005 to June 2007, total 263 patients were treated for nasal bone fracture. Among these patients, 57 patients (21%) had the additional operation with nasal fracture reduction. The additional operations were categorized in three types: augmentation rhinoplasty with tip plasty (40%), septoplasty only (16%), corrective rhinoplasty (44%). The mean follow-up period was 5.6 months and results were evaluated by scoring. Results: Forty four of 57 patients (77%) were highly satisfied regardless of any additional operation kinds. The complications were one septal perforation, two displacement of implant and four remnant nasal deformities. For the septal perforation, no further management was performed because we lost the contact with the patient. Then 4 of the other complicated patients were revised. Conclusion: In general, many physicians tend to consider nasal fracture as a simple trauma. However through the strict history taking, physical examination and professional counseling, we could catch the patient's cosmetic desire and get the eyes on new concept: the nasal fracture is not only a trauma but a cosmetic and functional field. In the treatment of nasal bone fracture, if additional rhinoplasty is performed, patients will be more satisfied and we also can expect higher profits.

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.77-80
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• 2008

Purpose: The majority of nasal fractures have been treated by closed reduction. And they were manipulated under local anesthesia or general anesthesia. Under the local anesthesia, patients can feel the pain and fear, so general anesthesia through the endotracheal intubation became popularized recently to treat the nasal fracture. But it has still the drawbacks of postanesthetic complication. Therefore, under the mask ventilation anesthesia using oral airway, we tried to manipulate the nasal fracture. Methods: From July 2007 to November 2007, we worked with fifty patients that were manipulated the nasal fracture. Fifty patients were divided into two groups, general anesthesia with the endotracheal intubation group(n=25) and the mask ventilation using oral airway group(n=25). We checked up the anesthesia time, postanesthetic complication, postoperative aesthetic & functional problem of nose in two groups. Results: In total operation time and sore throat frequency among the postoperative anesthetic complications, there was statistically significant difference between the mask ventilation group and the endotracheal intubation group(p<0.05). But there was no difference statistically in nausea frequency(p>0.05). And no patients complained of postoperative nasal complication such as septal deviation, septal perforation, nasal obstruction and hump nose in two groups. Conclusion: Through the mask ventilation using oral airway, we could reach satisfactory results in the anesthetic time and postanesthetic complication.

• Journal of Preventive Medicine and Public Health
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• v.27 no.3 s.47
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• pp.517-530
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• 1994

For the purpose of providing the basic data for health management of workers who are exposed to chromium and for improving the quality of working environment, the authors evaluated blood and urinary level of chromium, the occupational history. AST, ALT, Hb, Hct, nasal specular examinaton on 287 workers who have been dealed chromium compounds in 56 manufacturing Industries of five types, that is, 38 metal plating services(plating),4 manufacture of other fabricated metal products (fabricated metal product), 5 manufacturing of dyestuff(dyestuff), 6 dressing and dyeing of leather(leather), 3 others(manufacture of pottery and ceramic househod wares, motor vehicles, electronic valves and tubes and other electronic components) and also measured the level of chromium in air from February to October 1993. The results were as follows ; 1. The utilized type of chromium compounds was the hexavalent state in plating fabricated metal product dyestuff, leather and the trivalent state in .other, and atmosperic chromium concentration as geometric mean was $0.0138mg/m^3(0.001{\sim}0.068mg/m^3)$ in plating, $0.0115mg/m^3(0.006{\sim}0.015mg/m^3)$ in fabricated matal product, $0.068mg/m^3(0.002{\sim}0.019mg/m^3)$ in dyestuff, $0.0083mg/m^3(0.002{\sim}0.028mg/m^3)$ in leather $0.0039mg/m^3(0.003{\sim}0.005mg/m^3)$ in other by the type of industry and it exceeded TLV-TWA ($0.05mg/m^3$) in five (13.6%) of plating services. 2. The geometric mean of chromium in blood was $1.54{\mu}g/dl(0.10{\sim}3.62{\mu}g/dl)$ in Plantng, $0.94{\mu}g/dl(0.27{\sim}2.82{\mu}g/dl)$ in fabricated metal product, $0.51{\mu}g/dl(0.10{\sim}3.25{\mu}g/dl)$ in dyestuff, $0.87{\mu}g/dl(0.15{\sim}8.00{\mu}g/dl)$ in leather, $0.55{\mu}g/dl(0.20{\sim}2.28{\mu}g/dl)$ in other by the type of industry(p<0.001). 3. The geometric mean of chromium in urine was $14.47{\mu}g/l(6.90{\sim}28.00{\mu}g/l)$ in planting, $4.63{\mu}g/l(0.24{\sim}43.00{\mu}g/l)$ in fabricated metal product, $5.93{\mu}g/l(1.00{\sim}33.00{\mu}g/l)$ in dyestuff, $11.09{\mu}g/l(0.80{\sim}48.00{\mu}g/l)$ in leather, $12.41{\mu}g/l(10.10{\sim}41.00{\mu}g/l)$ in other by the type of industry(p<0.001). 4. As the result of nasal specular examination, twenty four cases (8.4%) of nasal septal perforation among 287 total subjects was observed, and there were 17 (9.7%) cases in plating, 4 csaes (14.3%) in dressing and dyeing of leather. In the comparison of chromium concentration in blood and urine between the perforated group and non-perforated group, the perforated group showed a significantly higher value as $1.883{\pm}3.055{\mu}g/dl\;and\;0.793{\pm}0.815{\mu}g/dl$(P<0.001), $21.31{\pm}34.610{\mu}g/L\;and\;9.304{\pm}11.079{\mu}g/L$ (P<0.001). 5. The mean concentration of chromium in blood, urine and the mean level of AST, ALT, Hb and Hct in exposure group were higher than those of control group(p<0.001).