Structural Support: Surgeons extol the cartilage stability provided by a new nasal implant

"It is excellent in applications where temporary support without adding permanent bulk is needed," he said. "Surgeons must keep in mind that it is resorbable like a PDS suture, and once it resorbs in six months, the temporary support or bulk will be gone." Dr. Toriumi has worked as a paid consultant with Ethicon, as well as Mentor Worldwide, the distributor of the device.

Minas Constantinides, MD, director of facial plastic and reconstructive surgery at New York University Medical Center in New York City and also a paid consultant for Ethicon and Mentor Worldwide, started using the PDS plate in early 2011. He said it offers a "nice" way to secure septal extension grafts and is most useful for correcting a very crooked septum. "It has given me more confidence in performing extracorporeal septoplasty to straighten these extremely challenging cases," he said. "It makes achieving a straight and strong medial crural component much easier."

The implant is also indicated for select cases of rhinoplasty, he said, including use as a carrier for dorsal or lateral onlay grafts and to create stronger spreader grafts from smaller, weaker pieces of cartilage. Ear cartilage warping can also be controlled by stenting the curved section with the plate, he said.

Cost

The key factor preventing a more widespread use of this implant among otolaryngologists and other surgeons is its cost, according to Dr. Wong.

The current price of the PDS plate is $299.00 per sheet; it is sold in a package of three sheets for a list price of $897.00 per package. According to a spokesman for Mentor Worldwide LLC, distributor of the PDS plate, the company has reduced its original price of $449.00 per sheet ($1347.00 per package) since the launch of the implant early this year. Currently, he said, the implant is not covered by insurance.

"Cost is an issue," said Dr. Toriumi, "but, if needed, surgeons are not hesitating to use it."

Best Practices

Dr. Toriumi encourages surgeons to become educated on how and when to use the implant to avoid any complications that may occur if it is not used in appropriate situations.

Dr. Saleh proposes a general guideline for otolaryngologists and other physicians to help determine when to use the implant. "Use it as scaffolding to support reconstructed cartilage anywhere in the nose when other means are inadequate, insufficient or technically difficult," he said.