Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix

Abstract

Background Nasal septal perforation repair remains a challenge with no standard technique for repair recognized. Objective To describe the combination of an anterior ethmoidal artery flap with a collagen matrix inlay as a successful technique for nasal septal perforation repair. Methods A case series of consecutive patients who underwent nasal septal perforation repair with an anterior ethmoidal artery flap with an inlay collagen graft was conducted. Demographic data, preoperative features of the perforation (size, location, and presence of chondritis), and postoperative outcomes were analyzed; closure rate, mucosalization rate (of the contralateral side at 21 and 90 days), and complications (crusting, bleeding, obstruction, infection, and rehospitalization <30 days) were documented. Results Thirteen patients (age: 49 ± 15 years, 30.8% women) were assessed. The perforation size was 1.6 ± 0.9 cm (range: 0.3–3.5 cm) and located 1.2 ± 0.5 cm (range: 0.5–2.0 cm) posterior to the columella. Chondritis was present in 69.2%. The closure rate was 100% (95% confidence interval [CI]: 77%–100%) at both 21 and 90 days. One patient required a free mucosa graft to an area of persistent crusting on the contralateral side (7.7%). Complications were low; bleeding 0%, obstruction 7.7% (requiring corticosteroid injection of anterior ethmoidal artery flap), and 0% infection/rehospitalization. Conclusion Anterior ethmoidal artery flap with an inlay collagen matrix is a reliable technique to repair nasal septal perforation. This technique, with robust vascularity and wide angle of rotation, enables the closure of perforations both large (<50% total septum) and with anterior locations.

Long Term Outcomes of Nasoseptal Perforation Repair With an Anterior Ethmoidal Artery Flap

“…Considering our failures, in case of large (>2 cm) or far anterior perforations, autologous or synthetic grafts could be integrated to provide more stability and guide re-epithelialization, especially when mucosal edges are not closely approximated. 18,19 Alternatively, acellular cadaveric dermis is reported to provide a reliable scaffold for the migration and ingrowth of mucosa across the perforation. 20 On the other side, a conservative attitude or even a posterior septectomy could be considered.…”

Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft

“…However, it may not be obtained in sufficient quantity or be of adequate quality in revision surgery or in cases of septal perforation. 9,10 When cartilage is present, it may be thin, short, or deformed to be used. Autologous conchal cartilage has a natural curve and may not be sufficiently flattened to be used as a graft.…”

The Traumatic Nasal Deformity

“…In their series, Cavada et al presented a group of 13 patients. 17 The flap was combined with the use of a collagen matrix inlay graft in this particular series. The perforations were significant with a perforation size that averaged 1.6 with a range of 0.3 to 3.5 cm.…”