A Graduated Approach to the Repair of Nasal Septal Perforations

Abstract

Septal perforation is an avoidable complication of septal surgery, but it can also occur because of a variety of traumatic, iatrogenic, caustic, or inflammatory reasons. Symptoms usually are related to disruption of the normally laminar flow of air through the nasal passages. Crusting, bleeding, parosmia, and neuralgia can develop, leading the patient to seek medical care. When local hygiene and conservative care are unsuccessful in relieving symptoms, closure of the perforation is considered. Repair is often difficult because of the limited exposure and limited amounts of friable mucosa with impaired vascular supply. The failure of attempted closure of septal perforations can be as high as 80 percent. The authors have developed a graduated approach to the closure of septal perforations that tailors the surgical approach to the size and location of the defect. Perforations 0.5 to 2.0 cm in size were closed in 92.9 percent (13 of 14) of patients using an extended external rhinoplasty approach and bilateral posteriorly based mucosal flaps. Larger perforations (2.0 to 4.5 cm) were closed in 81.8 percent (18 of 22) of patients by a two-staged technique, using a midfacial degloving approach to medially advance posteriorly based, expanded mucosal flaps. With careful preoperative management and selection of the appropriate surgical technique, even moderate-to-large perforations can be repaired reliably with limited operative morbidity.

Repair of nasal septal perforations using auricular conchal cartilage graft in children: Report on three cases and literature review

“…Conclusions: Repair of nasal septal perforations is a challenging procedure especially in children. Good Various methods of surgical closure of the perforation have been described: advancement and suture of the perforation border [2], the use of an oral mucosal flap [3], temporalis fascia graft [4], conchal cartilage with perichondrium and mastoid periosteum [5], inferior turbinate flap [6], tragal cartilage with perichondrium and temporalis fascia [7], bone and temporalis fascia graft [8], acellular human dermal allograft [9] and two-stage expanded mucosal flaps [10] have been described. Despite the numerous techniques, there is no ideal surgery especially for larger perforations.…”

Rhinochirurgie bei Systemerkrankungen

“…Au ß erdem kann durch ein unkritisches rhinochirurgisches Vorgehen das Symptom Sattelnase bzw. Septumperforation als Manifestation einer noch lokalisierten Systemerkrankung verkannt werden und damit die M ö glichkeit einer fr ü hzeitigen Behandlung einer potentiell schwerwiegenden Systemerkrankung verz ö gert werden [131] . Gem ä ß einer begrenzten Datenlage k ö nnen bislang keine eigenst ä ndigen Techniken f ü r die Rhinochirurgie bei Nasendeformit ä ten infolge von Systemerkrankungen abgeleitet werden.…”

“…Septum buttons eine Option darstellen[146,148] . F ä llt die Entscheidung zum Septumperforationsverschluss, erfolgt der operative Eingriff nur bei reizlosen Schleimhautverh ä ltnissen nach intensiver Schleimhautrehabilitation[131,145] .Analog zur Korrektur von Nasendeformit ä ten infolge von Systemerkrankungen stellt die Implantation von autogenen Knorpelbzw. Knochentransplantaten einen wesentlichen Bestandteil des rhinochirurgischen Vorgehens dar, sodass die hierbei gesammelten Erfahrungen beim Verschluss von Septumperforationen herangezogen werden k ö nnen.…”

“…Grunds ä tzlich muss die Ursache, die zur Septumperforation gef ü hrt hat, ermittelt und beseitigt bzw. zumindest minimiert werden[131,144,145] . Konkret bedeutet dies das Erreichen einer langfristigen und stabilen Remission bzw.…”

Nasal and sinus endoscopy for medical management of resistant rhinosinusitis, including postsurgical patients

“…The septum is potentially vulnerable to injury after surgery, both from the patient and during postoperative debridement. 44,45 Retained secretions Retained mucus in the maxillary sinus may be caused by infection, inspissation of secretions, foreign body (rarely), abnormal mucus rheology, mucus recirculation, continued ostiomeatal obstruction, or mucociliary disturbance. It is not a sine qua non for infection.…”