Repair of large nasal septal perforations via the external rhinoplasty approach

Abstract

Septal surgery is the most common cause of septal perforation, but traumatic, iatrogenic, caustic, or inflammatory causes may also lead to perforation. Conversion of the normally laminar flow of air to turbulent flow through the nasal passages generates the sensation of nasal obstruction, facial pain, and pressure. Crusting around the perforation edge, which is often associated with whistling, bleeding, parosmia, and neuralgia, can develop and result in the patient seeking medical care. Local hygiene and conservative care remain the first line of treatment, but when they are unsuccessful at relieving symptoms, closure of the perforation is considered. Repair is made difficult by the limited exposure and the availability of only friable mucosa with impaired vascular supply. The failure rate of attempts to close septal perforations can be as high as 80%. Thorough preoperative management and selection of the appropriate surgical technique are essential to the successful repair of septal perforations. With an external rhinoplasty approach and bilateral, posteriorly based mucosal flaps, perforations up to 3 cm can be reliably closed. Larger perforations (3.0 to 4.5 cm) require a 2-staged technique, with a midfacial degloving approach to transpose posteriorly based, expanded mucosal flaps.