title: Titanium Mesh Nasal Repair without Nasal Lining.
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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zenga
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Katherine
authors.initials: K
authors.lastname: Kao
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Collin
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gross
authors.affiliation: Department of Otolaryngology, ENT Associates at GBMC, Baltimore, Maryland.
authors.forename: Samuel
authors.initials: S
authors.lastname: Hahn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: John J
authors.initials: JJ
authors.lastname: Chi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Branham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000601:surgery; D009666:Nose / Q000293:injuries / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013524:Surgical Flaps; D013526:Surgical Mesh / Q000009:adverse effects; D014025:Titanium
chemical_list: D014025:Titanium