Inoperable nasoseptal defects: closure with custom-made silastic prostheses

The therapy of choice in nasoseptal defects is reconstruction with vital respiratory mucosa; in particular, three-layer repair using the bridge-flap technique according to Schultz-Coulon is the most promising. Cases exceeding operative limitations can be treated with silastic buttons. Our aim was to overcome the disadvantages of prefabricated silastic obturators by using custom-made prostheses. A customised silastic prosthesis was made according to an endonasal cast taken under general anesthesia and then inserted either under general or local anesthesia, depending on the size of the prosthesis. Patients were asked to attend a re-examination and to retrospectively answer a questionnaire (Sinu-nasal Outcome Test-20 German adapted Version [SNOT-20 GAV]), in addition to a number of questions typical for nasoseptal defects. Of the 14 patients, 12 answered the questionnaire and eight could be re-examined after a mean of 12 months. One patient had died, while in another patient the prosthesis had been removed due to pain prior to follow-up. A total of 11 patients had subjectively benefitted from the prosthesis. Symptom-intensity grades according to the SNOT-20 GAV increased by one grade and by two grades for the additional items typical for nasoseptal defects. The insertion of a custom-made silastic prosthesis represents an effective and safe supplement in the therapy of inoperable nasoseptal defects. The SNOT-20 GAV is only of limited value for the assessment of outcome of therapy for nasoseptal defects.