Download PDF
Facial Plast Surg 2017; 33(01): 052-057
DOI: 10.1055/s-0036-1593747
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Titanium Mesh Nasal Repair without Nasal Lining

Joseph Zenga
1   Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
Katherine Kao
1   Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
Collin Chen
1   Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
Jennifer Gross
1   Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
Samuel Hahn
2   Department of Otolaryngology, ENT Associates at GBMC, Baltimore, Maryland
,
John J. Chi
1   Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
Gregory H. Branham
1   Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
22 February 2017 (online)

Also available at
    Permissions and Reprints

Abstract

The objective of this study was to describe outcomes for patients who underwent titanium mesh reconstruction of full-thickness nasal defects without internal lining repair. This is a retrospective cohort study. Patients with through-and-through nasal defects were identified at a single academic institution between 2008 and 2016. Nasal reconstruction was performed with either titanium mesh and external skin reconstruction without repair of the intranasal lining or traditional three-layer closure. Five patients underwent titanium mesh reconstruction and 11 underwent traditional three-layer repair. Median follow-up was 11 months (range, 2–66 months). The only significant difference between groups was older age in patients undergoing titanium reconstruction (mean, 81 vs. 63 years; difference of 18; 95% confidence interval [CI], 4–32 years). Defect extent including overall size and structures removed was similar between groups (p > 0.05). Paramedian forehead flap was the most common external reconstruction in both groups (100% for titanium mesh and 73% for three-layer closure). Time under anesthesia was significantly shorter for titanium mesh reconstruction (median, 119 vs. 314 minutes; difference of 195; 95% CI, 45–237). Estimated blood loss and length of hospital stay were similar between groups (p > 0.05). Complication rates were substantial although not significantly different, 40 and 36% in titanium and three-layer reconstruction, respectively (p > 0.05). All patients with complications after titanium reconstruction had prior or postoperative radiotherapy. Titanium mesh reconstruction of through-and-through nasal defects can successfully be performed without reconstruction of the intranasal lining, significantly decreasing operative times. This reconstructive technique may not be suitable for patients who undergo radiotherapy.

Keywords

nasal - surgery - mesh - titanium
 

  • References

  • 1 Gillies H. Plastic Surgery of the Face. London, England: Oxford Medical Publishers; 1920
    Google Scholar
  • 2 Menick FJ. The evolution of lining in nasal reconstruction. Clin Plast Surg 2009; 36 (3) 421-441
    CrossrefPubMedGoogle Scholar
  • 3 Weber SM, Wang TD. Options for internal lining in nasal reconstruction. Facial Plast Surg Clin North Am 2011; 19 (1) 163-173
    CrossrefPubMedGoogle Scholar
  • 4 Silistreli OK, Demirdöver C, Ayhan M, Oztan Y, Görgü M, Ulusal BG. Prefabricated nasolabial flap for reconstruction of full-thickness distal nasal defects. Dermatol Surg 2005; 31 (5) 546-552
    CrossrefPubMedGoogle Scholar
  • 5 Scheithauer MO, Rotter N, Lindemann J, Schulz M, Rettinger G, Veit JA. The auricle's cavum conchae composite graft in nasal reconstruction. Am J Rhinol Allergy 2013; 27 (2) e53-e57
    CrossrefPubMedGoogle Scholar
  • 6 Ulug BT, Kuran I. Nasal reconstruction based on subunit principle combined with turn-over island nasal skin flap for nasal lining restoration. Ann Plast Surg 2008; 61 (5) 521-526
    CrossrefPubMedGoogle Scholar
  • 7 Park SS, Cook TA, Wang TD. The epithelial ‘turn-in’ flap in nasal reconstruction. Arch Otolaryngol Head Neck Surg 1995; 121 (10) 1122-1127
    CrossrefPubMedGoogle Scholar
  • 8 Haack S, Fischer H, Gubisch W. Lining in nasal reconstruction. Facial Plast Surg 2014; 30 (3) 287-299
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Collins JB, Czerwinski M. Contralateral dorsally based septal mucoperichondrial page flap, for nasal lining reconstruction. J Craniofac Surg 2015; 26 (4) 1352-1354
    CrossrefPubMedGoogle Scholar
  • 10 Scheithauer MO. Surgery of the turbinates and “empty nose” syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg 2010; 9: Doc03
    PubMedGoogle Scholar
  • 11 Moore EJ, Strome SA, Kasperbauer JL, Sherris DA, Manning LA. Vascularized radial forearm free tissue transfer for lining in nasal reconstruction. Laryngoscope 2003; 113 (12) 2078-2085
    CrossrefPubMedGoogle Scholar
  • 12 Seth R, Revenaugh PC, Scharpf J, Shipchandler TZ, Fritz MA. Free anterolateral thigh fascia lata flap for complex nasal lining defects. JAMA Facial Plast Surg 2013; 15 (1) 21-28
    CrossrefPubMedGoogle Scholar
  • 13 Acikel C, Bayram I, Eren F, Celikoz B. Free temporoparietal fascial flaps and full-thickness skin grafts in aesthetic restoration of the nose. Aesthetic Plast Surg 2002; 26 (6) 416-418
    CrossrefPubMedGoogle Scholar
  • 14 Burget GC, Walton RL. Optimal use of microvascular free flaps, cartilage grafts, and a paramedian forehead flap for aesthetic reconstruction of the nose and adjacent facial units. Plast Reconstr Surg 2007; 120 (5) 1171-1207 , discussion 1208–1216
    CrossrefPubMedGoogle Scholar
  • 15 Schubert W, Gear AJ, Lee C , et al. Incorporation of titanium mesh in orbital and midface reconstruction. Plast Reconstr Surg 2002; 110 (4) 1022-1030 , discussion 1031–1032
    CrossrefPubMedGoogle Scholar
  • 16 Bikhazi NB, Chow AW, Maas CS. Nasal reconstruction using a combination of alloplastic materials and autogenous tissues: a surgical alternative. Laryngoscope 1997; 107 (8) 1086-1093
    CrossrefPubMedGoogle Scholar
  • 17 Tsiliboti D, Antonopoulos D, Spyropoulos K, Naxakis S, Goumas P. Total nasal reconstruction using a prelaminated free radial forearm flap and porous polyethylene implants. J Reconstr Microsurg 2008; 24 (6) 449-452
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Otero-Rivas MM, González-Sixto B, Alonso-Alonso T, Pérez-Bustillo A, Valladares-Narganes LM, Rodríguez-Prieto MÁ. Titanium mesh in reconstructive surgery of the nasal pyramid. Follow-up of our 11 initial cases. Int J Dermatol 2015; 54 (8) 961-965
    CrossrefPubMedGoogle Scholar
  • 19 Rodriguez-Prieto MA, Alonso-Alonso T, Sánchez-Sambucety P. Nasal reconstruction with titanium mesh. Dermatol Surg 2009; 35 (2) 282-286
    CrossrefPubMedGoogle Scholar
  • 20 Rodríguez-Prieto MA, Pérez-Bustillo A, Alonso-Alonso T, Sánchez-Sambucety P. Partial nasal reconstruction with titanium mesh: report of five cases. Br J Dermatol 2009; 161 (3) 683-687
    CrossrefPubMedGoogle Scholar
  • 21 Henry EL, Hart RD, Mark Taylor S , et al. Total nasal reconstruction: use of a radial forearm free flap, titanium mesh, and a paramedian forehead flap. J Otolaryngol Head Neck Surg 2010; 39 (6) 697-702
    PubMedGoogle Scholar
  • 22 Horn D, Engel M, Bodem JP, Hoffmann J, Freudlsperger C. Reconstruction of a near-total nasal defect using a precontoured titanium mesh with a converse scalping flap. J Craniofac Surg 2012; 23 (5) e410-e412
    CrossrefPubMedGoogle Scholar
  • 23 Daneshi A, Mohammadi S, Javadi M, Hassannia F. Repair of large nasal septal perforation with titanium membrane: report of 10 cases. Am J Otolaryngol 2010; 31 (5) 387-389
    CrossrefPubMedGoogle Scholar
  • 24 Peckitt NS. Stereoscopic lithography: customized titanium implants in orofacial reconstruction. A new surgical technique without flap cover. Br J Oral Maxillofac Surg 1999; 37 (5) 353-369
    CrossrefPubMedGoogle Scholar
  • 25 Patterson AR, Fenton O, Loukota RA. Reply to ‘Raghavan U, Jones NS. The complications of giant titanium implants in nasal reconstruction. J Plast Reconstr Aesthetic Surg (2006);59:74-79’. J Plast Reconstr Aesthet Surg 2006; 59 (12) 1470-1471
    PubMedGoogle Scholar