Abstract
The re-approximation of septal flaps after septoplasty or septorhinoplasty may be complicated by a septal perforation. In the usual operative sequence the mucoperichondrial flaps are elevated on either side of the septum and after morselization the cartilage is placed back into the septal pocket for support and preservation of the integrity of the septum itself. Re-approximation of the septal flaps, septal suturing, septal splints, and packing have all been used alone or in combination to close the septal pocket and prevent hematoma. In order to determine the effects of suturing the septum on the formation of septal perforations, the rat ear was chosen as the experimental model. Like the nasal septum it is made up of a cartilaginous framework covered on both sides by skin. Unlike the nose, the lining is epithelium and not pseudostratified columnar ciliated respiratory epithelium. However, the healing and absorbing qualities of the two types of epithelium are very similar in nature.
Three different types of suture material were placed in the rat ear. Chromic and polyglycolic acid absorbable sutures were placed in the ear and followed grossly and histologically until completely absorbed. A stainless steel staple was used as a control to determine if the epithelium would “pierce” the ear similar to the technique of piercing the ears for earrings. The results of this study show that as the absorbable suture is dissolved the diameter of the tract through the ear gradually decreases and healing occurs without a permanent perforation. However, the stainless steel staple allowed the epithelium to migrate along the shaft, producing a perforation. From these results, the conclusion can be made that suturing the septum with an absorbable suture probably does not contribute significantly to permanent septal perforations.
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