What is the safest method for removing a Gore-Tex (expanded polytetrafluoroethylene) implant from the nose?

Safe Removal of Gore-Tex Nasal Implants

The safest approach for removing a Gore-Tex implant from the nose is through an endonasal incision (when the original placement was endonasal), followed by copious saline irrigation of the pocket and primary tension-free closure of the soft tissue envelope. 1

Surgical Approach

Incision Selection

• Use an endonasal approach when the original implant was placed endonasally, as this avoids external scarring and maintains nasal anatomy 1
• This approach is particularly important for preserving the aesthetic outcome while achieving complete implant removal 1

Intraoperative Technique

Key steps for safe removal:

• Perform meticulous dissection to identify the implant capsule and surrounding tissue planes 2, 3
• Remove the entire implant en bloc when possible to minimize tissue trauma and reduce the risk of retained fragments 2
• Perform copious saline irrigation of the pocket after implant removal to eliminate debris and reduce infection risk 1
• Achieve primary tension-free closure of the soft tissue envelope to optimize healing 1

Critical Considerations Based on Implant Duration

The histologic changes in Gore-Tex implants vary significantly with time:

• Implants in place for extended periods (>2 years) show tissue ingrowth into the central portions, enhanced adhesion to neighboring tissues, calcification, and structural changes 4
• Expect more difficult dissection with longer implantation periods due to tissue integration and fibrous capsule formation 4
• Be prepared for potential fragmentation during removal, as Gore-Tex structures can become destroyed and transformed over time 4

Postoperative Management

Immediate Post-Removal Care

• Avoid nose blowing for at least 1 week to prevent disruption of healing tissues 5
• Restrict flying, diving, forceful sneezing, and playing wind instruments for at least 6 weeks to minimize pressure changes that could compromise healing 5
• Keep nasal passages moist with saline sprays throughout the day to reduce crusting and facilitate healing 5
• Sleep with head slightly elevated to reduce edema and minimize bleeding risk 5

Activity Restrictions

• Avoid straining, lifting over 10 pounds, bending over, and exercising to prevent increased blood flow to the nose 5
• Avoid aspirin and ibuprofen unless otherwise instructed, as these may increase bleeding risk 5
• Acetaminophen is safe for pain control and does not increase bleeding 5

Antibiotic Considerations

• Consider systemic antibiotics given the removal of alloplastic material and potential contamination risk 5
• This is particularly important in revision cases, where infection rates are higher (5.4% in revision rhinoplasty versus 1.2% in primary cases) 3

Common Pitfalls and Contraindications

High-Risk Scenarios

Nasal septal perforation is a contraindication for Gore-Tex implantation and increases infection risk during removal—3 of 10 infected cases in one series had pre-existing septal perforations 3

Complication Rates to Anticipate

• Overall complication rate for Gore-Tex removal is approximately 3.2-3.8% in primary cases 2, 6
• Revision cases carry significantly higher risk (5.4% infection rate) compared to primary procedures 3
• Long-term implants (>2 years) may require more extensive dissection due to tissue ingrowth and calcification 4

Warning Signs Requiring Urgent Attention

Patients should be instructed to report immediately:

• Return of blood from nose or mouth 5
• Fever over 101°F 5
• Increasing pain 5
• Vision changes 5
• Loss of color around the skin of the nose 5
• Swelling of the face or diffuse skin rash 5

Follow-Up Protocol

• Schedule close follow-up to monitor for proper healing of nasal mucosa 5
• Assess for recurrent bleeding, which may occur from raw surfaces inside the nose 5
• Continue saline spray and moisturizing agents to prevent dry crusts and facilitate healing 5