Repair of Large Nasal Septal Perforations Using Facial Artery Musculomucosal (FAMM) Flap

Abstract

In summary, the advantages of the FAMM flap closure technique were (1) no visible external scar, with minimal donor site morbidity; (2) successful closure of large septal defects (>2 cm) with vascularized tissue in a single stage; and (3) resolution of patient symptomatology.

Effects of septal perforation on nasal airflow: computer simulation study

“…This perforation was cylindrical in shape, with a diameter of 5, 10 or 15 mm for a small, medium or large perforation, respectively. Our 15 mm diameter 'large' perforation was smaller than the 20 mm diameter perforation defined as a large perforation by Heller et al 3 This was because a 20 mm perforation was found to be too large for the relatively smaller Asian nose used in the present model and simulation.…”

“…larger than 2 cm in diameter). 3 Numerous clinical case studies have described the surgical treatments for this condition. 1 -6 However, relatively few experimental or computer-based studies have assessed the effects of septal perforation on nasal airflow and patency.…”

A Review of 25-Year Experience of Nasal Septal Perforation Repair

“…Various approaches have been advocated depending on the size and site of the perforation, including external rhinoplasty 6 ; alarotomy 7 ; and endonasal, 1 sublabial, 8,9 midfacial degloving, and endoscopic procedures 10,11 Surgical procedures include enlarging the perforation, 7 septal rotation flaps, 1,12,13 inferior turbinate pedicle flaps, 8 sublabial mucosal flaps, flaps, 16 tissue expansion, 17 and facial artery musculomucosal flaps. 18 Several autologous interposition grafts, including temporal muscle fascia, 1 septal cartilage, 19 nasal turbinate, 20 conchal cartilage, 21 mastoid bone with periosteum, 22 ear tragus cartilage with perichondrium, 23 perichondrocutaneous, 14 pericranium, 6 ethmoid bone, 6 and iliac crest, 19 as well as an acellular human dermal allograft, have also been used for SP repair. 13 Joseph, in 1931, and Safian, in 1935, brought into practice the technique proposed by Steifet in 1926, which was based on the transposition of an inferior turbinate flap.…”

Complex Nasal Reconstruction

“…It has been used successfully for reconstruction of various defects in nasal lining. 9,19,20 Unilateral or bilateral, superiorly based facial artery musculomucosal flaps provide moist mucosal lining based on an axial blood supply. This blood supply is quite robust, making it possible to raise very long flaps that can be folded for additional versatility.…”