Closure Of Nasal Septal Perforation Research Articles

Closure of Nasal Septal Perforations Using a Diced Cartilage in Fascia Graft.

The spectrum of surgical techniques in the repair of nasal septal defects is wide. The objective of this study was to assess the feasibility of using a diced cartilage in fascia (DC-F) graft for successful closure of nasal septal perforations and to evaluate symptom reduction. This was a retrospective study of 18 patients undergoing surgical repair of symptomatic nasoseptal perforations of different etiologies using a DC-F graft from 2020 until 2021. The procedure was feasible in all of the 18 patients. Reconstruction of septal defects with a DC-F graft led to reduction of crust formation, reduction of epistaxis, and improvement of nasal breathing in 13 out of the 18 patients when seen for their 2-month follow-up. Reperforation occurred in three cases, leaving defects of 1, 7, and 5 mm in diameter. In one case, the reperforation was symptomatic. A DC-F graft proved to be a reliable and reproducible method for the closure of nasoseptal perforations of variable sizes, of different locations, and of different etiologies.

Outcome of Endoscopic Repair of Nasal Septal Perforation.

The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The purpose of this study is to study the outcome of this technique. A retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap among 2 institutions from August 2020 to July of 2022 was conducted. Demographics and comorbidities were collected preoperatively and postoperatively. The main outcome of this study was to identify the risk factors for surgical failure. Forty-one patients were included. Mean perforation size was 2.2 cm (range 0.5-4.5 cm). Mean age was 42.5 years (range 14-65 years), 53.6% were female, 39% were active smokers, mean body-mass-index (BMI) was 31.9 (range 19.1-45.5), 20% with history of CRS and 31.7% had diabetes mellitus (DM). Etiologies of the perforation included idiopathic (n = 12), iatrogenic (n = 13), intranasal drug use (n = 7), trauma (n = 6), and secondary to tumor resection (n = 3). Overall success rate for complete closure was 73.2%. Active smoking, history of intranasal drug use, and DM were significantly associated with surgical failure (72.7%vs 26.7%, P = .007; 36.4%vs 10%, P = .047; and 63.6%vs 20%, P = .008 respectively). The endoscopic AEA flap is a reliable technique for closure of nasal septal perforation. It may not work when the etiology is intranasal drug use. Close attention to diabetes and smoking status is also needed.

Surgical closure of nasal septal perforation using mucosal flaps and interposed graft: a case series of 154 patients and literature review

Surgical closure of nasal septal perforation using mucosal flaps and interposed graft: a case series of 154 patients and literature review

Surgical closure of nasal septal perforation using mucosal flaps and interposed graft: a case series of 154 patients and literature review.

Surgical closure of nasal septal perforation using mucosal flaps and interposed graft: a case series of 154 patients and literature review.

A contemporary review of “realistic” success rates after surgical closure of nasal septal perforations

ObjectiveThe surgical closure of septal perforations is a challenging procedure. Various techniques exist. Each perforation proves that there is not the one precise procedure for all perforations. Nevertheless, success rates of about 90% are reported, although the procedure for closing the defect is challenging. Our goal was to evaluate the existing data. MethodsWe performed a contemporary review of published closure rates of septal perforations on order to compare the present results in the literature. The limitations of the respective studies were analyzed. ResultsWe found closure rates from 30 to 100%. Numerous procedures were described and combined. Prospective studies comparing different techniques are missing. The follow-up time in studies was quite short or not even specified. Studies on long-term success rates are rare. ConclusionThe closure of septal defects is one of the most challenging rhinosurgical interventions. Closure rates ≥90% as described in literature seem relatively high. One reason might be short follow-ups and retrospective study designs. Frequently, precise information on the follow-up and the method of follow up is missing. Thoroughly designed prospective studies are absent. Longer follow-up times are associated with lower complete closure rates. A long-term success rate between 70 and 80% seems realistic.

Closure of Nasal Septal Perforation

Symptomatic nasal septal perforations can lead to a substantial restriction in the quality of life of patients and present a distinct surgical challenge for the otolaryngologist/head and neck surgeon. Symptomatic patients complain about nasal crusting, recurrent nosebleeds and nasal obstruction. The so called 4 bridge-flap technique including the interposition of autologous ear cartilage presents an established surgical method for closure of a septal perforation. In the present article, the surgical procedure is described in detail.

TnR Nasal Mesh와 비강저 및 하비도 피판을 이용해 치유한 비중격 천공 1예

Nasal septal perforation is the destruction of the septal cartilage, bone, and mucosa due to previous septal surgeries, inflammation, trauma, drugs or malignancy. The surgical closure of nasal septal perforation is a challenging part. Many surgical techniques have been reported, but there is no standardized surgical method for treating septal perforation. We encountered a 63-year-old patient with a septal perforation. In this study the experiences with a new surgical material for closure of large perforations of the nasal septum are presented. This report suggests a new surgical technique of repairing septal perforation using a nasal floor and inferior meatus (NFIM) flap with TnR Nasal Mesh® as an alloplastic graft material. (J Clinical Otolaryngol 2020;31:98-102)

Use of bacterial cellulose in closure of nasal septal perforation

<p class="abstract"><strong>Background:</strong> 30 patients with nasal septal perforation after surgical correction of septal deviation undergoing trials of septal closure were divided into 2 groups to compare between results of free inferior turbinate graft with bacterial cellulose and results of free inferior turbinate graft only in closure of nasal septal perforation. To compare between results of free inferior turbinate graft with bacterial cellulose and results of free inferior turbinate graft only in closure of nasal septal perforation.</p><p class="abstract"><strong>Methods:</strong> Prospective randomized study in which 30 patients with nasal septal perforation after surgical correction of septal deviation undergoing trials of septal closure were divided into 2 groups; group I (15 patients) in which free inferior turbinate graft with bacterial cellulose would be used in closure of nasal septal perforation; group II (15 patients) in which free inferior turbinate graft only would be used in closure of nasal septal perforation. </p><p class="abstract"><strong>Results:</strong> Septal perforation healing (closure) would be in 10 patients in group I while in 6 patients in group II. Improvement in nasal obstruction, crustion, epistaxis and breathing sound in group I would be better than in group II.</p><p class="abstract"><strong>Conclusions:</strong> Use of free inferior turbinate graft with bacterial cellulose would be an effective method than use of free inferior turbinate graft only in closure of nasal septal perforation.</p>

Free Cartilage-Mucosa Composite Graft for Closure of Nasal Septal Perforations

I present a method for repair of nasal septal perforations utilizing a free cartilage/mucosal composite graft. This technique is unique in its simplicity and in its ability to minimize complications. Further studies will be necessary to determine whether the simplicity of this technique is sufficient for successful closure of nasal septal perforations.

Nasal septum perforation – new treatment methods

Perforation is a defect of nasal septum manifested by the disruption of mucosa in the cartillaginous or bone part of nasal septum or in both of the parts at the same time.As a result, disruption of air transport through the nose and impaired nasal physiology occur. Crusting, epistaxis, and wheezing arise. Perforations are classified according to their size, type, and localization. There are many causes for nasal septum perforation: trauma, surgery, tumors, coexistence of inflammatory, infectious, degenerative, and autoimmune diseases, and cocaine abuse. The assessment of a patient with nasal septum perforation includes detailed medical history, physical examination, diagnostic and laboratory tests. Treating the underlying disease is of primary importance. The second step involves closing the perforation. Perforations can be treated conservatively (pharmacologically) or surgically. The choice of approach depends on the etiology, size, and location of the perforation. Surgical approach is the most effective. Surgical closure of nasal septal perforation is a difficult procedure associated with many complications. All surgical approaches are based on two main principles: creating mucosal, mucoperichondrial, and/or mucoperiosteal flaps or transplant. Prosthetic treatment is another solution. Literature data shows that highest success rate is achieved after surgical procedures with the use of mucosal flaps and temporal fascia transplants, as well as acellular human dermal allografts.

Endoscopic repair of nasal septal perforation.

SUMMARYSurgical closure of nasal septal perforation is one of the most challenging procedures in nasal surgery. During the last decade, many endoscopic repair techniques have been described with a success of post-operative repair between 76.4% and 100%. The advantages of this approach are its minimal invasiveness (with no external scars), optimal exposure of the operative field (with better visibility of structures) and good control of perforation margins. The drawbacks are that it is time-consuming and can be difficult to perform, requiring years of endoscopic experience. In this review, all the relevant literature published in which repair was completely made endoscopically is overviewed, comparing the success rates, diameter of the perforation and materials used for the repair.

Closure of nasal septal perforations with a polydioxanone plate and temporoparietal fascia in a closed approach.

Septal perforation closure is still often invasive and complex, with relatively low closure rates. We aimed to provide the first results of a case series of 20 patients with nasal septal perforations who underwent septal perforation repair by both an open and a minimally invasive technique by using a graft that consisted of temporoparietal fascia and a polydioxanone (PDS) plate without mucosal flaps. Between 2014 and 2016, we tested, for the first time, the feasibility of the insertion of this graft via a hemitransfixion incision at our institution. The rationale for the closed approach was to avoid any visible nasal scars. We reported our results of both approaches. The septal perforations were closed by insertion of a graft, which consisted of a 0.25-mm PDS flexible plate enveloped by temporoparietal fascia, into the perforation. The insertion of the graft was performed either via a columellar incision (open approach) or via a cosmetically advantageous hemitransfixion incision (closed approach) in an underlay technique. No attempts were made to close the perforation by mucosal flap rotation and/or advancement. Protective silastic sheeting to both sides of the perforation provided fixation to the graft while natural mucosal healing occurred over the perforation in the course of 3 to 8 weeks. Eighteen of 20 perforations were closed by mucosa at the last follow-up. The mean follow-up was 8.7 months. Thirteen patients had surgery via the closed approach. We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.

Endoscopic closure of large septal perforations with bilateral Hadad–Bassagasteguy flaps

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Three-dimensional printing of large nasal septal perforations for optimal prosthetic closure.

Since 1972, patients with large nasal perforations, who were symptomatic, and who were not candidates for surgery, had the option of custom prosthetic closure at Mayo Clinic. Although septal prostheses have helped many patients, 27% of pre-1982 patients chose not to keep the prosthesis in place. Two-dimensional computed tomography (CT) sizing resulted in more of the patients choosing to retain the prosthesis. The introduction of three-dimensional (3-D) printing to the sizing process offered the potential of further improved retention by refinement in prosthesis fit. To describe the fabrication of nasal septal prostheses by using 3-D printing for sizing and to compare the retention rate of 3-D-sized prostheses with those that used previous sizing methods. Twenty-one consecutive patients who had placement of septal prostheses sized by using 3-D printed templates were studied. CT image data were used to print 3-D templates of the exact shape of the patient's septal perforation, and medical-grade silastic prostheses were fabricated to fit. In four cases, the 3-D printed template allowed preoperative surgical simulation. Metrics collected included prosthesis retention; symptoms, including intranasal crusting and epistaxis; and previous prosthetic closure failures. Twenty of the twenty-one patients had improvement in symptoms. The mean diameter of the perforations was 2.4 cm; the mean closure time by the end of the study period was 2.2 years. All but two patients chose to keep their prosthesis in place, for a retention rate of 90%. Seven patients with successful closure had failed previously with prior prosthesis sized without the current 3-D printing methodology. This 90% retention rate exceeded the previous rates before the introduction of 3-D sizing. Sizing done by 3-D printing for prosthetic closure of nasal septal perforations resulted in a higher retention rate in helping patients with these most-challenging nasal septal perforations.

Experience with plastic closure of nasal septal perforation in children and adolescents

Experience with plastic closure of nasal septal perforation in children and adolescents

Olfaction improvement after nasal septal perforation repair with the "cross-stealing" technique.

The surgical treatment of nasal septal perforation is known to improve nasal respiratory airflow and, thereby, should be beneficial to the patient's olfactory abilities. However, there are only limited data on the effect of nasal septal perforation repair (NSPR) on olfaction, and most studies reported contradictory results. The aim of this prospective study was to investigate the change in the olfactory abilities of 42 patients with a primary concern of nasal septal perforation. NSPR was performed with the "cross-stealing" technique. The inferior-based mucoperichondrial flap in one side and the superior-based mucoperichondrial flap from the other side of the nasal septum were passed to the opposite sides through the perforation. Surgery was completed by placing an interpositional graft between the flaps before suturing. The interpositional grafts were residual cartilage. The olfactory performance of the patients before and at 1, 3, and 6 months after the closure of the nasal septal perforation was measured by using an olfaction test kit. The success rate with complete closure of nasal septal perforation with the "cross-stealing" technique was 92.8%. Analysis of the data indicated statistically significant improvement in olfactory function scored as odor threshold (T), odor discrimination (D), odor identification (I) and TDI at 1, 3, and 6 months after NSPR (p < 0.001 for all). The mean TDI score evaluated 6 months after NSPR was improved by 64%. Analyses of variance indicated statistically significant improvement in olfactory scores within time factors were calculated as preoperative versus 1, 3, and 6 months; 1 versus 3 and 6 months; and 3 versus 6 months (p < 0.001 for all). Analysis of the present data indicates a beneficial effect of NSPR on olfactory abilities of patients with perforation. Our data on the short- and long-term olfactory abilities of 42 patients with nasal septal perforation after NSPR when using an olfaction test kit indicated statistically significant improvement in olfactory function.

Endonasal Septal Perforation Repair Using an Interpositional Porcine Dermal Collagen Implant

Objectives: Describe our novel minimally invasive technique for closure of nasal septal perforations. Methods: We describe our experience in a series of patients from 2 London teaching hospitals treated using the same surgical technique. Closure of the defect was undertaken using one inferiorly based nasal floor mucosal flap and a contra-lateral superiorly based vascularized septal mucosal flap. This was achieved by a closed endonasal approach with a porcine dermal collagen sheet interpositional graft (Permacol) placed on the more concave side of the perforation. The mucosal flaps are used to cover the repair and sutured in place. Results: Septal perforations of up to 2-cm diameter were successfully repaired in greater than 90% of cases over a 36-month follow-up period. Conclusions: Our novel technique has proved effective in closure of septal perforations. Permacol is a durable graft, utilizing acellular cross-linked collagen matrix, used commonly in abdominal hernia repair. We found Permacol to be a biocompatible graft with the ability to resist dessication if there is slow re-epithelization or partial exposure, making it a robust and easy to use interpositional graft with no morbidity from graft harvesting. The use of local intranasal mucosal advancement flaps allows a minimally invasive approach without any external incisions or scars. Potential limitations are the size of the pedicled flaps for very large perforations, or the lengths of the flaps for very anterior defects. For the majority of septal perforations the authors feel this technique offers an effective minimally invasive option with low morbidity.

Closure of nasal septal perforations using bilateral intranasal advancement/rotation flaps.

This study aims to report our experience on surgical repair of nasal septal perforations (NSP) using bilateral intranasal advancement/rotation flaps with open septoplasty technique. Medical records of 28 consecutive patients who were operated for NSP in our clinic between January 2009 and February 2013 were retrospectively analyzed. Demographic features of the patients and surgical results were evaluated. The most common cause of NSP was previous septal surgery in 18 (64%) of the patients. Nasal crusting was the most common symptom in 21 patients (75%). Perforation size ranged from 10 to 30 mm in diameter. Septoplasty was performed in five patients, while septorhinoplasty was performed in three patients simultaneously to the NSP repair. Nasal septal cartilage and auricular chonchal cartilage were used to support the nasoseptal skeleton, if required. There were no major intra- or postoperative complications. The mean postoperative follow-up period was 23 months. During follow-up, there was mild columellar retraction in five patients (18%). Nasal septal perforation was closed successfully in 24 patients (86%). Pinpoint perforation remained in two patients and perforation size was smaller than 5 mm in two patients. Closing the NSP with bilateral intranasal advancement/rotation flaps has a comparable high success rate. Therefore, this technique can be easily applied to small-medium sized septal perforations.

Endoscopic Repair of Nasal Septal Perforations Using Modified Pedicled Inferior Turbinate Flap

Endoscopic Repair of Nasal Septal Perforations Using Modified Pedicled Inferior Turbinate Flap Background: Septal perforations are usually difficult to treat. Surgery is indicated if the perforation is symptomatic. Our aim is to evaluate endoscopic closure of nasal septal perforation using pedicled inferior turbinate flap. Patients and Methods: Endoscopic closure of nasal septum perforations were performed in 31 patients using unilateral pedicled inferior turbinate flap. Results: Twenty-three patients (74%) had complete closure of their perforations. Six other patients (19.5%) had incomplete closure with a small residual perforation< 1cm in diameter posteriorly. Two patients (6.5%), who had previous submucosal diathermy of the inferior turbinate, had flap necrosis with complete failure of the repair. There was a significant inverse relationship between the diameter of the perforation and the success of the repair. Conclusions: Endoscopic repair of nasal septal perforations, up to 2 cm in diameter, using a modified pedicled inferior turbinate flap, is a feasible technique that offers acceptable success rates due to the remarkable vascularity and thickness of the flap. The use of endoscopes allowed more precise a traumatic elevation of the flap posteriorly. The present technique differs from other previously described flap procedures in that it extends the posterior dissection to include a part of the mucosa of the inferior meatus in order to allow more free un-constrained rotation of the flap, and decrease the thickness of the pedicle so that we may not need to divide it in a second stage. This step would have been more difficult and less precise without the use of the endoscope. Previously operated turbinates are not suitable for this technique. Also the procedure may not be suitable if the perforation is very anterior or larger than 2 cm in diameter.

Endonasal repair of septal perforations using a rotational mucosal flap and acellular dermal interposition graft

The closure of nasal septal perforations can be challenging based on the etiology, location, and method of closure. We report on a novel method of closure for nasal septal perforations using a unilateral mucosal rotational flap and acellular dermal interposition graft. Twenty patients with nasal septal perforations of various etiologies underwent our method of repair through a closed, endonasal approach. Out of 20 patients, 17 demonstrated successful closure of their septal perforations, consistent with an 85% success rate. Based upon size, closure rates were 89% for small perforations (<1 cm), 80% for medium perforations (1-2 cm), and complete closure for a single large perforation (>2 cm). Of 20 patients, 19 were completely asymptomatic following surgical intervention, and of the 3 with failed repairs, only 1 patient required revision surgery for persistent symptoms. Nasal septal perforations may cause bothersome symptoms and present a significant reconstructive challenge. Native septal tissue is advantageous due to a rich vascular supply and proximity to the defect, while interposition grafts act as a scaffold for the migration of respiratory mucosa. The method described herein combines these principles to provide a suitable technique for the closure of nasal septal perforations.