Clin Exp Otorhinolaryngol.  2008 Sep;1(3):154-157. 10.3342/ceo.2008.1.3.154.

Endoscopic Repairment of Septal Perforation with Using a Unilateral Nasal Mucosal Flap

• Lee HR
• Ahn DB
• Park JH
• Kim YH
• Sin CM
• Youn SJ
• Kim JS

• KMID: 1486086
• DOI: http://doi.org/10.3342/ceo.2008.1.3.154

Abstract

OBJECTIVES
Nasal septal perforation is an anatomic defect of the cartilaginous and bone tissues of the nasal septum. Many approaches and techniques to repair nasal septal perforations have been reported on. The purpose of this paper is to report on our surgical technique and the results of the treatment for nasal septal perforations.
METHODS
From May 2001 to March 2008, 14 patients (12 males and 2 females; mean age: 41.3 yr) were enrolled. The mean perforation size was 15 mm, and all the perforations were located at the cartilaginous portion. Our surgical technique is based on an endoscope-assisted endonasal approach, with dissection of unilateral advanced mucosal flaps with using a temporalis fascia graft. The follow-up periods ranged from 3 to 23 months (mean follow-up period: 8 months).
RESULTS
Using our surgical technique on 14 patients, 12 cases (85.7%) of septal perforation were closed without complication. The remaining two patients (14.3%) had incomplete closures (about 2-3 mm) without any significant symptoms related to the remaining perforation.
CONCLUSION
Our technique is a viable procedure with a high success rate for achieving closure of nasal septal perforations. It has the advantages of shortening the operative time, no external incision and avoiding any other perforation during the operation. Therefore, we consider it to be a good alternative for repairing nasal septal perforations.

Keyword

Nasal septum; Surgery

MeSH Terms

Bone and Bones
Fascia
Follow-Up Studies
Humans
Male
Nasal Septal Perforation
Nasal Septum
Operative Time
Transplants

Figure

• 

  Fig. 1 The hemitransfixion incision and the incision for mucosal advancement. The hemitransfixion incision was extended laterally to under the inferior turbinate for the lower mucosal flap and the other incision for the upper mucosal flap was made on the septal dorsum.

• 

  Fig. 2 The nasal septal mucosa was not yet healed by the postoperative 5th week. ST: septum.

• 

  Fig. 3 The nasal septal perforation was completely covered with nasal mucosal epithelium at the second postoperative month. ST: septum

Reference

1. Tasca I, Compadretti GC. Closure of nasal septal perforation via endonasal approach. Otolaryngol Head Neck Surg. 2006; 12. 135(6):922–927. PMID: 17141085.

2. Ayshford CA, Shykhon M, Uppal HS, Wake M. Endoscopic repair of nasal septal perforation with acellular human dermal allograft and an inferior turbinate flap. Clin Otolaryngol Allied Sci. 2003; 2. 28(1):29–33. PMID: 12580877.

3. Presutti L, Alicandri Ciufelli M, Marchioni D, Villari D, Marchetti A, Mattioli F. Nasal septal perforations: our surgical technique. Otolaryngol Head Neck Surg. 2007; 3. 136(3):369–372. PMID: 17321861.

4. Osma U, Cüreoğlu S, Akbulut N, Meriç F, Topçu I. The results of septal button insertion in the management of nasal septal perforation. J Laryngol Otol. 1999; 9. 113(9):823–824. PMID: 10664685.

5. Eng SP, Nilssen EL, Ranta M, White PS. Surgical management of septal perforation: an alternative to closure of perforation. J Laryngol Otol. 2001; 3. 115(3):194–197. PMID: 11244524.

6. Romo T 3rd, Foster CA, Korovin GS, Sachs ME. Repair of nasal septal perforation utilizing the midface degloving technique. Arch Otolaryngol Head Neck Surg. 1988; 7. 114(7):739–742. PMID: 3289581.

7. Hier MP, Yoskovitch A, Panje WR. Endoscopic repair of a nasal septal perforation. J Otolaryngol. 2002; 10. 31(5):323–326. PMID: 12512899.

8. Brain DJ. Septo-rhinoplasty: the closure of septal perforations. J Laryngol Otol. 1980; 5. 94(5):495–505. PMID: 7400678.

9. Fairbanks DN. Closure of nasal septal perforations. Arch Otolaryngol. 1980; 8. 106(8):509–513. PMID: 6994705.

10. Ohlsén L. Closure of nasal septal perforation with a cutaneous flap and a perichondrocutaneous graft. Ann Plast Surg. 1988; 9. 21(3):276–288. PMID: 3223709.

11. Kridel RW. Septal perforation repair. Otolaryngol Clin North Am. 1999; 8. 32(4):695–724. PMID: 10433664.

12. Kridel RW, Appling WD, Wright WK. Septal perforation closure utilizing the external septorhinoplasty approach. Arch Otolaryngol Head Neck Surg. 1986; 2. 112(2):168–172. PMID: 3510639.

13. Meghachi AS, Jankowski R, Védrine PO, Dugny O. Endoscopic closure of septal perforations by mucosal rotation flaps. Ann Otolaryngol Chir Cervicofac. 2004; 9. 121(4):222–228. PMID: 15545930.

14. Tipton JB. Closure of large septal perforations with a labial-buccal flap. Plast Reconstr Surg. 1970; 11. 46(5):514–515. PMID: 4919288.

15. Woolford TJ, Jones NS. Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft. J Laryngol Otol. 2001; 1. 115(1):22–25. PMID: 11233616.

16. Kridel RW. Considerations in the etiology, treatment, and repair of septal perforations. Facial Plast Surg Clin North Am. 2004; 11. 12(4):435–450. PMID: 15337112.

17. Cottle MH. Nasal atrophy, atrophic rhinitis, ozena: medical and surgical treatment: repair of septal perforations. J Int Coll Surg. 1958; 4. 29(4):472–484. PMID: 13539430.

18. Kridel RW, Foda H, Lunde KC. Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg. 1998; 1. 124(1):73–78. PMID: 9440784.

19. Yousef-Mian M. Repair of nasal septal perforation. Am J Rhinol. 1997; Jan–Feb. 11(1):35–40. PMID: 9065345.