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Surgical closure of nasal septal perforation using mucosal flaps and interposed graft: a case series of 154 patients and literature review

Published online by Cambridge University Press:  25 November 2021

E G Heywood ,
M Daoud ,
A Talawdekar ,
N Ashraf  and
U Raghavan
E G Heywood
Affiliation:
Department of ENT and Facial Plastic Surgery, Doncaster and Bassetlaw NHS Foundation Trust
M Daoud*
Affiliation:
Department of ENT and Facial Plastic Surgery, Doncaster and Bassetlaw NHS Foundation Trust
A Talawdekar
Affiliation:
Department of ENT and Facial Plastic Surgery, Doncaster and Bassetlaw NHS Foundation Trust
N Ashraf
Affiliation:
Department of ENT and Facial Plastic Surgery, University Hospital of Derby and Burton NHS Foundation Trust, UK
U Raghavan
Affiliation:
Department of ENT and Facial Plastic Surgery, Doncaster and Bassetlaw NHS Foundation Trust
*
Author for correspondence: Dr M Daoud, Department of ENT and Facial Plastic Surgery, Doncaster Royal Infirmary, Thorne Road, Doncaster DN2 5LT, UK E-mail: facialplasticsurgeonuk@yahoo.com
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Abstract

Background

Nasal septal perforations are defects of the septum. Symptomatic patients failing conservative measures may be considered for surgery; however, the surgery is challenging. This study describes a technique involving mucosal advancement flaps and autologous or acellular porcine interposition grafts and assessed the long-term closure rate and symptom control.

Method

This study looked at patients with symptomatic septal perforations who underwent surgery between 2005 and 2017. Symptoms were assessed pre- and post-operatively using a visual analogue scale. A literature search was performed for septal perforation repair techniques and outcomes.

Results

A total of 95 per cent of patients had complete closure of their septal perforations, 90 per cent had complete symptom control. There were statistically significant differences between the pre- and post-operative mean visual analogue scale score for epistaxis (p < 0.001), crusting (p < 0.001), whistling (p < 0.001) and nasal obstruction (p < 0.001).

Conclusion

Surgical closure of nasal septal perforations with mucosal advancement flaps and an interposition graft is a reliable technique with excellent long-term outcomes.

Keywords

Nasal SeptumNasal Septal PerforationRhinoplasty
Type
Main Article
Information
The Journal of Laryngology & Otology , First View , pp. 1 - 10
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr M Daoud takes responsibility for the integrity of the content of the paper

References

Kridel, RWH, Delaney, SW. Simultaneous septal perforation repair with septorhinoplasty: a 31 year experience. Facial Plastic Surgery 2018;34:298–311Google Scholar
Ribeiro, JS, da Silva, GS. Technical advances in the correction of septal perforation associated with closed rhinoplasty. Arch Facial Plast Surg 2007;9:321–7Google Scholar
Islam, A, Celik, H, Felek, SA, Demirci, M. Repair of nasal septal perforation with "cross-stealing" technique. Am J Rhinol Allergy 2009;23:225–8Google Scholar
Teymoortash, A, Werner, JA. Repair of nasal septal perforation using a simple unilateral inferior meatal mucosal flap. J Plast Reconstr Aesthet Surg 2009;62:1261–4Google Scholar
Dosen, LK, Haye, R. Surgical closure of nasal septal perforation, early and long term observations. Rhinology 2011;49:486–1Google Scholar
Wong, S, Raghavan, U. Outcome of surgical closure of nasal septal perforation. J Laryngol Otol 2010;124:868–74Google Scholar
Park, JH, Kim, DW, Jin, HR. Nasal septal perforation repair using intranasal rotation and advancement flaps. Am J Rhinol Allergy 2013;27:42–7Google Scholar
Chen, FH, Rui, X, Deng, J, Wen, YH, Xu, G, Shi, JB. Endoscopic sandwich technique for moderate nasal septal perforations. Laryngoscope 2012;122:2367–72Google Scholar
Raol, N, Olson, K. A novel technique to repair moderate-sized nasoseptal perforations. Arch Otolaryngol Head Neck Surg 2012;138:714–6Google Scholar
Lee, DH, Yoon, TM, Lee, JK. Clinical utility of the inferior turbinate flaps in the reconstruction of the nasal septum and skull base. J Craniofac Surg 2012;23:322–6Google Scholar
Tastan, E, Aydogan, F, Aydin, E. Inferior turbinate composite graft for repair of nasal septal perforation. Am J Rhinol Allergy 2012;26:237–42Google Scholar
Chhabra, N, Houser, SM. Endonasal repair of septal perforations using a rotational mucosal flap and acellular dermal interposition graft. Int Forum Allergy Rhinol 2012;2:392–6Google Scholar
Yenigun, A, Meric, A, Verim, A, Ozucer, B, Yasar, H, Ozkul, MH. Septal perforation repair: mucosal regeneration technique. Eur Arch Otorhinolaryngol 2012;269:2505–10Google Scholar
Ma, YX, Tao, AZ, Lu, C, Tian, H, Dong, BC. Endoscopic repair of nasal septal perforation with acellular dermal matrix and pedicled mucoperichondrial flap [in Chinese]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011;46:455–8Google Scholar
Castelnuovo, P, Ferreli, F, Khodaei, I, Palma, P. Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 2011;13:411–4Google Scholar
Teymoortash, A, Hoch, S, Eivazi, B, Werner, JA. Experiences with a new surgical technique for closure of large perforations of the nasal septum in 55 patients. Am J Rhinol Allergy 2011;25:193–7Google Scholar
Taskin, U, Yigit, O, Sisman, SA. Septal perforation repairing with combination of mucosal flaps and auricular interpositional grafts in revision patients. Otolaryngol Head Neck Surg 2011;145:828–32Google Scholar
Li, F, Liu, Q, Yu, H, Zhang, Z. Pedicled local mucosal flap and autogenous graft for the closure of nasoseptal perforations. Acta Otolaryngol 2011;131:983–8Google Scholar
Giacomini, PG, Ferraro, S, Di Giarolamo, S, Ottaviano, F. Large nasal septal perforation repair by closed endoscopically assisted approach. Ann Plast Surg 2011;66:633–6Google Scholar
Mansour, HA. Repair of nasal septal perforation using inferior turbinate graft. J Laryngol Otol 2011;125:474–8Google Scholar
Rokkjær, MS, Barrett, TQ, Petersen, CG. Good results after endonasal cartilage closure of nasal septal perforations. Dan Med Bull 2010;57:A4196Google Scholar
Kazkayasi, M, Tuna, E, Kilic, C. Bullous middle turbinate flap for the repair of nasal septal perforation. J Otolaryngol Head Neck Surg 2010;39:203–6Google Scholar
Daneshi, A, Mohammadi, S, Javadi, M, Hassannia, F. Repair of large nasal septal perforation with titanium membrane: report of 10 cases. Am J Otolaryngol 2010;31:387–9Google Scholar
Dhar, V, Watts, S. Closure of nasal septum perforation: a novel technique. Clin Otolaryngol 2009;34:403–4Google Scholar
Lee, HR, Ahn, DB, Park, JH, Kim, YH, Sin, CM, Youn, SJ et al. Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap. Clin Exp Otorhinolaryngol 2008;1:154–7Google Scholar
Lee, KC, Lee, NH, Ban, JH, Jin, SM. Surgical treatment using an allograft dermal matrix for nasal septal perforation. Yonsei Med J 2008;49:244–8Google Scholar
Barry, C, Eadie, PA, Russell, J. Radial forearm free flap for repair of a large nasal septal perforation: a report of a case in a child. J Plast Reconstr Aesthet Surg 2008;61:996–7Google Scholar
Shikowitz, MJ. Vascularized mucoperiosteal pull through flap for closure of large septal perforation: a new technique. Laryngoscope 2007;117:750–5Google Scholar
Ceylan, A, Ileri, F, Celenk, F, Yilmaz, M, Uslu, S. Upper lateral cartilage inner mucoperichondrial flap technique for the repair of nasal septal perforation. ORL J Otorhinolaryngol Relat Spec 2007;69:245–50Google Scholar
Kilty, SJ, Brownrigg, PJ, Safar, A. Nasal septal perforation repair using an inferior turbinate flap. J Otolaryngol 2007;36:38–42Google Scholar
André, RF, Lohuis, PJ, Vuyk, HD. Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines. J Plast Reconstr Aesthet Surg 2006;59:829–34Google Scholar
Heller, JB, Gabbay, JS, Trussler, A, Heller, MM, Bradley, JP. Repair of large nasal septal perforations using facial artery musculomucosal (FAMM) flap. Ann Plast Surg 2005;55:456–9Google Scholar
Friedman, M, Ibrahim, H, Ramakrishnan, V. Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 2003;113:1425–8Google Scholar
Zhang, Q, Zhang, J, Li, S. Endoscope-assisted repair of large nasal septal perforation using a complex mucoperichondrial flap and free tissue graft. Chin Med J 2003;116:157–8Google Scholar
Newton, JR, White, PS, Lee, MSW. Nasal septal perforation repair using open septoplasty and unilateral bipedicled flaps. J Laryngol Otol 2003;117:52–5Google Scholar
Mobley, SR, Boyd, JB, Astor, FC. Repair of a large septal perforation with a radial forearm free flap: brief report of a case. Ear Nose Throat J 2001;80:512Google Scholar
Woolford, TJ, Jones, NS. Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft. J Laryngol Otol 2001;115:22–5Google Scholar
Foda, HM. The one-stage rhinoplasty septal perforation repair. J Laryngol Otol 1999;113:728–33Google Scholar
Flavill, E, Gilmore, JE. Septal perforation repair without intraoperative mucosal closure. Laryngoscope 2014;124:1112–7Google Scholar
Emsen, I, Murat, A. Different approach to the reconstruction of nasal septum perforations: Alar winged flap. J Craniofac Surg 2015;26:1536–3732Google Scholar
Altun, H, Hanci, D. Olfaction improvement after nasal septal perforation repair with the "cross stealing" technique. Am J Rhinol Allergy 2015;29:142–5Google Scholar
Hanci, D, Altun, H. Repair of nasal septal perforation using middle turbinate flap (monopedicled superiory based bone included conchal flap): a new unilateral middle turbinate mucosal flap technique. Eur Arch Otolaryngol 2015;272:1707–12Google Scholar
Sharma, A, Janus, J, Diggelmann, HR, Hamilton, GS. Healing septal perforations by secondary intention using acellular dermis as a bioscaffold. Ann Otol Rhinol Laryngol 2015;124:425–9Google Scholar
Kaya, E, Cingi, C, Olgun, Y, Soken, Hakan PÖ. Three layer interlocking: a novel technique for repairing a nasal septum perforation. Ann Otology Rhinol Laryngol 2015;124:212–15Google Scholar
Virkkula, P, Mäkitie, AA, Vento, SI. Surgical outcome and complications of nasal septal perforation repair with temporal fascia and periosteal grafts. Clin Med Insights Ear Nose Throat 2015;8:7–11Google Scholar
Cassano, M. Endoscopic repair of nasal septal perforation with "slide and patch" technique. Otolaryngol Head Neck Surg 2014;151:176–8Google Scholar
Ozturk, S, Zor, F, Ozturk, S, Kartal, O, Alhan, D, Isik, S. A new approach to objective evaluation of the success of nasal septum perforation. Arch Plast Surg 2014;41:403–6Google Scholar
Ozdek, A, Bayır, O, Dündar, Y, Tatar, EC, Saylam, G, Korkmaz, M H. Closure of nasal septal perforations using bilateral intranasal advancement/rotation flaps. Kulak Burun Bogaz Ihtis Derg 2014;24:123–8Google Scholar
Beckmann, N, Ponnappan, A, Campana, J, Ramakrishnan, VR. Posterior septal resection: a simple surgical option for management of nasal septal perforation. JAMA Otolaryngol Head Neck Surg 2014;140:150–4Google Scholar
Jeon, EJ, Cho, J, Lee, JH, Kim, SW, Nam, IC, Park, Yong S et al. The role of temporalis fascia for free mucosal graft survival in small nasal septal perforation repair. J of Craniofac Surg 2014;25:164–6Google Scholar
Foda, HMT, Magdy, EA. Combining rhinoplasty with septal perforation repair. Facial Plas Surg 2006;22:281–8Google Scholar
Hong, SN, Mutsumay, S, Jin, HR. Long-term results of combined rhinoplasty and sept perforation repair. J Facial Plast Surg 2016;18:475–80Google Scholar