Repair of Septal Perforation with Endoscopic-Assisted Pericranial Flap Harvest and Open Rhinoplasty Approach

Predictors of Success of Endonasal Septal Perforation Repair: A 10-Year Experience

Background: There is no consensus on optimal repair technique for nasal septal perforations (NSPs). Objective: To measure success rate and evaluate predictors of success for NSP repair. Methods: Medical records of patients who underwent NSP repair from 2010 to 2020 were reviewed. Included patients had at least 60 days of postsurgical follow-up. Surgical technique involves an endonasal approach; subperichondrial dissection with local flap mobilization; and multilayer closure using cartilage interposition graft, fascia graft, and mucoperichondrial flaps. A chi-squared test or Fisher exact test was used for statistical analysis. Results: Eighty-one repairs were performed with a closure rate of 86%. The median patient age was 46 years (range 13-77); 34.6% of perforations were ≥2 cm. Conchal (77.8%), rib (7.4%), or septal (7.4%) cartilage was used as graft material. A complication rate of 8.6% was reported. Perforation size or graft material had no impact on successful closure rate. Of patients with failed repairs, 55% had perioperative complications or conditions associated with poor healing. Conclusion: An endonasal approach for NSP repair showed a high success rate across diverse presentations; however, NSP repair was significantly more likely to be successful in patients without perioperative complications or pre-existing conditions associated with poor wound healing.

Repair of Large Nasal Septal Perforations Using the Upper Lateral Cartilage Mucosal Flap

OBJECTIVES/HYPOTHESIS

To describe the surgical technique and closure outcomes of larger septal perforation repair incorporating mucosa from the undersurface of the upper lateral cartilage into a superiorly positioned advancement flap.

STUDY DESIGN

Retrospective case series.

METHODS

A chart review was performed for patients who underwent perforation repair utilizing bilateral nasal mucosal flaps which incorporated mucosa from the undersurface of the upper lateral cartilage into the superior flap between January 2009 and December 2020.

RESULTS

Sixty-six patients met study criteria. Prior septal surgery was the most common (28.8%) etiology. Mean perforation length and height were 18.9 and 14.4 mm, respectively. Complete perforation closure was noted in 91.2% of patients followed for a minimum of 6 months (mean follow-up time 32.1 months). Twelve patients underwent secondary surgery for persistent nasal obstruction. Postoperative loss of dorsal height was noted in seven patients. The NOSE-perf scores were available for the last 15 repairs and demonstrated significant symptom improvement from a mean score of 26.4 (95% confidence interval [CI], 5.2) to 14.5 (95% CI, 5.2) (P < .0001).

CONCLUSION

The ventral surface of the upper lateral cartilage can provide additional mucosa for incorporation into a superior advancement flap to achieve successful closure for larger septal perforations. Optimization of surgical outcomes for this challenging condition may require secondary functional or aesthetic procedures.

LEVEL OF EVIDENCE

IV Laryngoscope, 2021.

Endonasal and Endoscopic Repair of Nasal Septal Perforation with an Autologous Fascia Lata Graft

Importance: We propose a novel technique utilizing both a headlight and an endoscope to repair large iatrogenic septal perforations using autologous fascia lata grafts and extended pedicled mucosal flaps. Objective: The use of an autologous fascia graft, a fat graft, and an extended pedicled mucosal flap enables the closure of a large and anterior perforation of the nasal septum. This approach is an effective and applicable method for nasal septal perforation repair.