Comment on: Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review

We read with great interest the article by Levin et al. , “Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review,” published in Facial Plastic Surgery. The review comprehensively summarized the literature on the use of polydioxanone (PDS) plates in nasal septal perforation repair and highlighted promising results with high closure rates and minimal complications. However, we would like to respectfully draw attention to one of the included studies, which may not directly pertain to septal perforation repair. The cited paper by Menger DJ, Tabink IC, and Trenité GJ (Arch Otolaryngol Head Neck Surg. 2008;134(8):842–847) describes nasal septal reconstruction following abscess formation in children, using autologous cartilage grafts mounted on a PDS plate. This study focused on septal integrity restoration after abscess-related cartilage loss rather than closure of a preexisting septal perforation. Moreover, while other studies in the review included perforations smaller than 10 mm, this particular paper was noted as involving perforations of 15 mm or greater. A careful review of the original article, however, reveals that the mentioned 15 mm refers not to the diameter of a septal perforation but to the size of the cartilaginous defect resulting from infection. Therefore, the inclusion of this reference in a systematic review specifically addressing nasal septal perforation reconstruction may not be fully appropriate. While the use of PDS plates in various nasal reconstructive settings is certainly valuable, distinguishing between septal reconstruction after abscess and true perforation repair is essential for accurate synthesis of the literature and interpretation of outcomes. We commend the authors for their thorough review and valuable contribution to the field. We hope this clarification will assist in refining the evidence base and support future research on the optimal use of PDS plates in nasal septal surgery.