Polyethylene implants in nasal septal restoration.

IMPORTANCE: Numerous techniques have been described to repair nasal septal perforations (SPs). However, many are technically challenging, with varying degrees of success. OBJECTIVE: To evaluate the use of polyethylene (Medpor; Porex Technologies) implants in the closure of nasal SPs. DESIGN AND SETTING: Prospective cohort study in an academic research setting. PARTICIPANTS: Fourteen patients with a nasal SP were identified between March 1, 2008, and February 1, 2011. INTERVENTION: Each patient underwent repair of the nasal SP with a polyethylene orbital sheet implant. After measuring the size of the SP, the implant was trimmed and shaped to fit appropriately. The implant was then placed between bilateral mucoperichondrial flaps using an endonasal approach. MAIN OUTCOME AND MEASURE: Successful closure of the nasal SP with an intact polyethylene graft and complete remucosalization by the 1-year follow-up visit. RESULTS: The most common initial symptoms of SPs were nasal obstruction, crusting, and epistaxis. The SPs ranged from 0.5 to 4.0 cm in diameter. Thirteen of 14 patients (93%) who underwent repair of their nasal SPs with a polyethylene implant had successful closure. CONCLUSION AND RELEVANCE: The use of polyethylene implants is effective and technically easy and is associated with low patient morbidity because it does not require the harvesting of tissue from other donor sites. LEVEL OF EVIDENCE: 4.

Effectiveness of the heat-activated nitinol smart piston stapes prosthesis in stapedectomy surgery.

OBJECTIVE: To compare the SMart piston stapes prosthesis to a standard manual crimp prosthesis on operative time and air-bone gap (ABG) closure in stapedectomy. DESIGN: Retrospective chart review. SETTING: Tertiary referral centre. METHODS: The charts of patients undergoing stapedectomy for otosclerosis were analyzed. We compared the results of 76 patients (80 ears) who received the autocrimping SMart piston prosthesis to those of 21 patients (21 ears) who received the conventional manual crimp Fisch-type prosthesis. Data were analyzed using t-test, chi-square, or two-way analysis of variance where appropriate. MAIN OUTCOME MEASURE: Operative time with ABG closure as a secondary outcome measure. RESULTS: There was a significant difference in operative time between the Fisch-type prosthesis and the SMart piston prosthesis groups. The operation required 28.9 ± 3.2 minutes when using the Fisch-type prosthesis, whereas 21.2 ± 2.4 minutes were needed when using the SMart piston (p < .001). There was a significant improvement in postoperative ABG for both the Fisch-type piston (28.1 ± 3.1 to 9.0 ± 1.4, p < .001) and the SMart piston (25.1 ± 3.7 to 8.2 ± 2.5, p < .001) groups. CONCLUSIONS: Use of the SMart piston prosthesis results in ABG closure similar to that of the traditional Fisch-type prosthesis but offers the added advantage of reduced operative time.