|
1
|
Garaycochea O, Santamaría-Gadea A, Alobid I. State-of-the-art: septal perforation repair. Curr Opin Otolaryngol Head Neck Surg 2023; 31:11-16. [PMID: 36729895 DOI: 10.1097/moo.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW To provide a comprehensive overview of the evolution of the different techniques described for the surgical repair of nasal septal perforation, and a surgical decision-making algorithm for its surgical treatment. RECENT FINDINGS Septal perforation surgery has evolved and improved in recent years. It has gone from being an avoided or discouraged surgical procedure to a procedure with success rates of >90%. Nowadays, there is no standard approach or single technique. The different techniques described include unilateral random pattern flaps, interposition grafts, unilateral pedicle septal local flaps, free mucosal grafts and bilateral random patter flaps. The incidence of success is higher in pediculated septal flaps such as the anterior ethmoidal artery flap or the greater palatine artery pedicled flap combined with additional techniques. SUMMARY Nowadays, surgical closure of septal perforation is possible and should be an option to consider in symptomatic patients without response to medical treatment. The surgical approach that we recommend when planning the surgical closure of nasal septum (or nasoseptal) perforation is based on the osseocartilaginous support and the location of the defect.
Collapse
Affiliation(s)
- Octavio Garaycochea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University. Barcelona
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona
| | - Alfonso Santamaría-Gadea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University. Barcelona
- Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
| |
Collapse
|
|
2
|
Moreno-Luna R, Sánchez FM, Kaen A, Cabrerizo JRG, Castro NM, García JG, Aubá JMV, Ruiz-Valdepeñas EC, Cánovas IM, Del Cuvillo Bernal A, Piñero AG, Solano JMM, de Liesa RF, Sánchez-Gómez S, Alobid I. Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:323-335. [PMID: 36031110 DOI: 10.1016/j.otoeng.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.
Collapse
Affiliation(s)
- Ramón Moreno-Luna
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ariel Kaen
- Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Nieves Mata Castro
- Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Madrid, Spain
| | - Jaime González García
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José Miguel Villacampa Aubá
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Irene Monjas Cánovas
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Alfonso Del Cuvillo Bernal
- Unidad de Rinología, Hospital Universitario de Jerez, Cádiz, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Juan Manuel Maza Solano
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Rafael Fernández de Liesa
- Servicio de de Otorrinolaringología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Serafín Sánchez-Gómez
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain; Comisión de Formación de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Isam Alobid
- Unidad de Base de Cráneo, Departamento de Otorrinolaringología, Hospital Clínic, Barcelona, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC).
| |
Collapse
|
|
3
|
Moreno-Luna R, Mariño Sánchez F, Kaen A, Gras Cabrerizo JR, Mata Castro N, González García J, Villacampa Aubá JM, Cárdenas Ruiz-Valdepeñas E, Monjas Cánovas I, Del Cuvillo Bernal A, García Piñero A, Maza Solano JM, Fernández de Liesa R, Sánchez-Gómez S, Alobid I. Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(21)00041-8. [PMID: 34330369 DOI: 10.1016/j.otorri.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.
Collapse
Affiliation(s)
- Ramón Moreno-Luna
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Ariel Kaen
- Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Nieves Mata Castro
- Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Madrid, España
| | - Jaime González García
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Miguel Villacampa Aubá
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Irene Monjas Cánovas
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, España
| | - Alfonso Del Cuvillo Bernal
- Unidad de Rinología, Hospital Universitario de Jerez, Cádiz, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Juan Manuel Maza Solano
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Rafael Fernández de Liesa
- Servicio de de Otorrinolaringología, Hospital Universitario Miguel Servet, Zaragoza, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Serafín Sánchez-Gómez
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España; Comisión de Formación de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Isam Alobid
- Unidad de Base de Cráneo, Departamento de Otorrinolaringología, Hospital Clínic, Barcelona, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC).
| |
Collapse
|
|
4
|
Abstract
PURPOSE OF REVIEW Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment. RECENT FINDINGS NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience. When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.
Collapse
|