Clin Exp Otorhinolaryngol.  2011 Sep;4(3):137-141.

The Reconstruction of Nasal Septal Perforation with High Density Porous Polyethylene Covered with Fascia Lata: An Experimental Study on Rabbit Model

• Yildirim G
• Onar V
• Sayin I
• Onol SD
• Aydin T

Abstract

OBJECTIVES
Evaluation of a new material, high-density porous polyethylene (HDPP), which is covered with fascia lata, for experimental nasal septal perforation closure.
METHODS
Twenty New Zealand albino rabbits were included and divided into study and control groups. A lateral incision was made from the lateral aspect of the left nares to the incisura nasomaxillaris. After exposure of the cavum nasi, the nasal mucoperichondrium was elevated bilaterally. A full-thickness 0.5x0.5-cm perforation was created over the septum nasi with a No. 11 surgical blade. A fascia lata graft was used for the study group. The HDPP was covered with fascia lata and placed under the elevated mucosa. HDPP without a fascial covering was used in the control group. Four months after the procedure, magnetic resonance imaging was performed to evaluate resorption of the material. The animals were sacrificed, and the nasal septum was completely removed. Macroscopic and histopathological examinations were performed on the nasal septum.
RESULTS
All rabbits had survived after the 4-month period. Macroscopically, nine of 10 (90%) perforations were closed in the fascia lata-covered HDPP group. Histopathological examination of these nine rabbits revealed that the continuity of cartilage was disturbed in the perforation areas. Granulation tissue was inverted in areas in which the cartilage continuity was disturbed. The HDPP had remained intact at the edge of the perforation. In the HDPP group, six of 10 implants were still perforated (60%) and four (40%) were closed. The fascia lata-covered HDPP implant had a significantly higher perforation closure rate than that of the HDPP implant alone (P<0.05).
CONCLUSION
In cases of septal perforation, it is better to cover the HDPP implant with fascia lata. This covered implant can be used for the repair of nasal septal perforations. HDPP implants are easy to work with and avoid the increased operative time and morbidity associated with harvesting autografts.

Keyword

Medpor; High-density porous polyethylene; Septum perforation; Fascia lata; Reconstruction

MeSH Terms

Animals
Cartilage
Fascia
Fascia Lata
Granulation Tissue
Magnetic Resonance Imaging
Mucous Membrane
Nasal Septal Perforation
Nasal Septum
New Zealand
Operative Time
Polyethylene
Polyethylenes
Pyridones
Rabbits
Transplants
Polyethylene
Polyethylenes
Pyridones

Figure

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  Fig. 1 Fascia lata-covered high-density porous polyethylene implant (black arrow) and its placement in the nasal septum (white arrow).

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  Fig. 2 Replacement of cartilage into the nasal septum (white arrow).

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  Fig. 3 The T1-weighted magnetic resonance imaging scan of the high-density porous polyethylene implant shows a hyperintense area. The graft material is intact and not resorbed (arrow).

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  Fig. 4 Microscopic section of the perforation area (H&E, ×100) cartilage (thin black arrows). The continuity of cartilage was disturbed in the perforation areas. Fibrovascular tissue was inverted in areas in which the cartilage continuity was disturbed (thick black arrow). The Medpore stayed intact at the edge of the perforation (white arrows).

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  Fig. 5 Microscopic section of the high-density porous polyethylene implant (H&E, ×200). Fibrovascular tissue was inserted into the pores of the implant (black arrows).

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