Cross-septal returned flap: modified endoscopic technique for bilateral closure of septal perforation

Rusetsky, Yu. Yu.; Mokoyan, Zhanna; Spiranskaya, O. A.; Arutyunyan, Sergey

doi:10.1016/j.ijom.2020.01.026

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…An overview of included studies, their respective ENSPR strategies, and postoperative outcomes are outlined in Table 1. 1,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] According to the MINORS criteria, the articles included in this review were of moderate quality and risk of bias when assessed at the study level (mean score: 9.4, range: 6-13) (Supplemental Table 1).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…7 With limited local tissue available for repair, surgeons have become increasingly innovative in repair design. An example includes the cross-septal return flap utilized by Rusetsky et al, 28 in which a single mucosal flap is used to provide bilateral coverage by passing it through a transfixion incision. In a systematic review by Kim and Rhee 11 which incorporated endonasal, endoscopic, and open rhinoplasty approaches, bilateral flap coverage was found to be significantly superior to unilateral flap coverage (84.5% vs 73.4% successful closure, respectively).…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

“…6 Recent studies reported the use of novel intranasal repair methods with the use of local grafts and vascularized flaps. 1,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The objective of this study is to provide a comprehensive review of the purely endonasal endoscopic approaches used to repair NSPs. We also aim to provide a pooled descriptive analysis of closure outcomes associated with these innovative surgical techniques to potentially guide treatment decisions in patients with NSPs.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Techniques for Nasal Septal Perforation Repair: A Systematic Review

Gravina

Pai

Shave

et al. 2022

Ann Otol Rhinol Laryngol

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Objectives: Surgical repair of nasal septal perforations (NSPs) is technically challenging. Advantages associated with endoscopic NSP repair (ENSPR) include enhanced visualization and its minimally invasive nature. Purely endoscopic techniques have successful outcomes with low morbidity. This study provides a review of clinical features, surgical techniques, and outcomes in patients who underwent ENSPR. Methods: A systematic review was conducted using PubMed/MEDLINE, Cochrane library, and Embase databases. Manual bibliography search produced additional articles. Studies reporting purely endoscopic approaches for NSP repair were included. Patient demographics, NSP size, etiology, repair strategy, incidence of closure, and follow-up were analyzed. Results: A total of 329 cases from 20 studies were included. The mean age was 37.2 years (range, 12.3-51 years) and 55.0% were male. Common etiologies were iatrogenic (n = 180, 60.0%), trauma (n = 66, 22.0%), and idiopathic (n = 36, 12.0%). The mean NSP size was 17.1 mm (range, 4-23). Repair techniques included unilateral random pattern flaps (n = 205, 62.3%), interposition grafts (n = 137, 41.6%), and unilateral axial pedicled local flaps (n = 81, 24.6%). 222 patients (67.5%) underwent a 2-layered repair, while 70 (21.3%) and 37 (11.2%) patients underwent single and 3-layered repairs, respectively. Successful closure was achieved in 296 patients (90.0%). When stratified by layers of repair, 65 single-layered (92.9%), 196 2-layered (88.3%), and 34 3-layered repairs (91.9%) were successful at a mean follow-up of 16.3 months (range, 3-31 months). Conclusions: ENSPR generally achieves NSP closure with high rates of success among varying types of repairs. Further studies may determine how clinical factors and surgical methods impact the likelihood of obtaining successful closure.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic Techniques for Nasal Septal Perforation Repair: A Systematic Review

Gravina

Pai

Shave

et al. 2022

Ann Otol Rhinol Laryngol

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Surgical repair of nasal septal perforations: A systematic review and meta‐analysis

Fermin

Bui

McCoul

et al. 2022

Int Forum Allergy Rhinol

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Background: A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes. Methods: PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes. Results:The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p < 0.01), with moderate heterogeneity between studies (I 2 = 42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes. Conclusion:Nasal septal perforation surgical repair success rates are comparable regardless of technique.

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