Closure Of Septal Perforations Research Articles

Simultaneous Rhinoplasty and Septal Perforation Repair Using the Bone-Cartilaginous Unit.

Various techniques are employed for septal perforation repair, but success rates still vary. Numerous mucosal flaps are used for septal perforation closure; however, a scaffold is essential for proper positioning and enhanced mucosal growth. To assess the effectiveness of using a septal bone/cartilage composite graft (BC unit) to close septal perforations in rhinoplasty patients and evaluate patient satisfaction. This case series included patients with septal perforation undergoing rhinoplasty and perforation repair from 2019 to 2023. BC units were used to cover the cartilaginous perforations in all patients. Patients were followed for a minimum of one year, assessing surgical results and postoperative satisfaction using the 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). In this study, 31 patients (22 female, 9 male) aged 34.80 ± 10.31 years (19-59 years) were enrolled. Nine had prior septoplasty, while four had undergone septorhinoplasty. The preoperative perforation size ranged from 6 to 27 mm (mean 14.1 mm). At final follow-up, 26 cases (83.8%) achieved complete closure, while three had incomplete closures, and two experienced reperforation. Analysis revealed a notable mean decrease of 31.93 (SD = 26.47) in obstruction domain scores (SCHNOS-O) and a mean decrease of 44.19 (SD = 25.37) in cosmesis domain scores (SCHNOS-C). Septal perforation repair and rhinoplasty can be safely and effectively performed concurrently using BC units for suitable candidates.

Interposition Technique for Septal Perforation Using a Composite Graft Made Up of Allograft Dermal Matrix and Autologous Cartilage

Background and Objectives Interposition using acellular allograft between perforated septal flaps is a popular procedure among surgeons because of its usefulness. However, allograft dermal matrix itself tends to become infected sometimes, and can easily undergo necrosis or be displaced from the implanted site. Here, the authors would like to introduce a newly devised interposition graft made up of allograft and cartilage, which is easy to manipulate and can be fixed in the desired position.Subjects and Method We performed a retrospective chart review from January 2018 to August 2020. A total of 12 patients with septal perforation who received surgical treatment were included in this study. Acellular human dermal allograft (MegaDerm® ; L&C Bio) was used as an interposition allograft piled up by autologous cartilage, and it was positioned between the mucoperichondrial flaps via the endonasal approach.Results The most common etiology was previous septal surgery (n=8); in one case, the etiology was repeated electrocauterization due to frequent epistaxis; the etiology was not verified for three cases. All 12 cases achieved the result of complete septal perforation closure. All patients on follow-up inquiry reported marked improvements in the visual analogue scale score (mean value, 4.1 to 1) and Nasal Obstruction Symptom Evaluation scale (mean value, 7.3 to 1.8).Conclusion Composite graft made up of cartilage and allograft dermal matrix achieved successful results without having to fix the graft. It can be an alternative technique to treat septal perforation for inexperienced surgeons and with a limited operation field.

Nasal Septal Perforation Closure by "Sandwich Grafts": Technique, Initial Results.

Nasal septal perforation closure represents a considerable surgical challenge. Many techniques rely on the implantation of foreign materials that pose a persisting threat of infection. The authors have identified a reliable technique closing septal perforations by an autologous "sandwich graft." It is layered around a piece of auricular cartilage, covered with temporal fascia, thus emulating the physiological layers of the nasal septum. Finally, the prepared graft is then sewn into the perforation in an underlay technique and kept in place by septal splints for 4 weeks. The technique is easily feasible and strives to reconstruct the nasal as physiological as possible. The data obtained from a case series of 11 patients highlights the efficacy of the technique.

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

Various graft materials have been used to repair nasoseptal perforation, but there is no standardized treatment method. The anterior maxillary sinus wall is flattened in appearance and can be easily obtained in a sufficient amount for a large-sized nasoseptal perforation. The aim of this study is to determine whether the anterior maxillary sinus wall is suitable as an interpositional graft in the surgical repair of septal or nasoseptal perforation. This is a retrospective review of 21 patients who underwent repair of nasoseptal perforation using anterior maxillary sinus wall as an interpositional graft. The etiology, pre- and post-operative NOSE and GBI score, and perforation size were reviewed. The surgical outcome was considered successful if total closure was achieved after postoperative follow-up. 19 of the 21 perforations were successfully repaired with anterior maxillary sinus wall. Failure of the repair was found in 2 patients. Causal etiology of perforation was previous septoplasty in 10 patients, and electrocautery in 1 case, but not identified in 10 cases. The largest size was 2.7 × 2.2 cm. The most common symptoms were epistaxis, crusting, and nasal obstruction. Closure of septal perforation resulted in improved subjective symptoms and quality of life which were evaluated with NOSE and GBI score. Anterior maxillary sinus wall as interpositional graft between mucoperichondrial flaps can be used to reliably repair nasoseptal perforations.

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.

Nasal Septal Perforation Repair with an Inferior Turbinate Flap and Acellular Dermal Matrix.

Nasal septal perforation is an uncommon disorder that can cause disturbance of nasal physiology. The perforations can vary widely in size, location, and symptomatology. Many different closure techniques have been described in the literature; however, no gold standard has been recognized. The choice of surgical technique usually depends on the characteristics of the perforation and surgeon experience. Due to the goal of perforation repair being restoration of normal nasal physiology, techniques with the best outcomes have been those resurfacing the septum with nasal respiratory mucosa. Here we present our novel surgical method for large (> 2 cm) septal perforation closure using a modification of the inferior turbinate flap repair using a polydioxanone plate and the acellular dermal matrix allograft (Alloderm, Allergan Inc.).

Endoscopic Repair of Nasal Septal Perforations With Fascia Lata.

Nasal septal perforation (NSP) consists of defects of mucosa, cartilage, and bone. Nasal septal surgery is by far the most common cause of NSP. Many surgical approaches have been described for NSP repair. In this study, the authors describe a novel technique for repairing all sizes of NSP using an only fascia lata graft. The authors implemented a retrospective study design. Seventeen patients who underwent NSP repair between January 2016 and January 2019 were included to the study. Entire nasal surgical steps were performed under endoscopic view, harvested fascia lata graft is placed in tympanoplasty fashion after all edges of perforation is elevated and implantation bed is prepared. The mean size of the septal peforations were 18.52 ± 4.17 mm horizontally, 11.52 ± 3.42 mm vertically. The mean follow up period was 14.47 ± 9.5 months (range: 2-36). In 15 of the 17 patients, total NSP closure was achieved (88,23%). Endoscopic close technique using fascia lata for nasal septal perforation closure is a safe and reliable technique with high success rate and it should be considered in patients with nasal septal perforation.

Resultados posoperatorios de cierre quirúrgico de perforación septal con injertos de cartílago

Introduccio?n: Las perforaciones septales y su correccio?n quiru?rgica constituyen un reto para los otorrinolaringo?logos. Se encuentran descritas en la literatura diferentes te?cnicas para el cierre de perforaciones septales; sin embargo, sus resultados en te?rminos de efectividad son muy variables y con pocos pacientes. Desde hace 8 an?os se viene realizando la te?cnica de cierre de perforacio?n septal con injertos de carti?lago en el servicio de otorrinolaringologi?a del Hospital San Jose? y se ha observado una respuesta cli?nica exitosa.
 Objetivo: describir los resultados postoperatorios de los pacientes manejados con la te?cnica de cierre quiru?rgico de perforacio?n septal con injertos de carti?lago, en te?rminos de aparicio?n de complicaciones y frecuencia de perforacio?n septal residual. Disen?o: estudio de tipo cohorte descriptiva.
 Metodologi?a: se describe una cohorte de pacientes manejados con la te?cnica de cierre quiru?rgico de perforacio?n septal con injertos de carti?lago de banco o carti?lago auto?logo. Se incluyeron pacientes a partir de enero de 2014 a junio de 2018. Se extrajeron de la historia cli?nica los datos demogra? cos, cli?nicos, complicaciones y presentacio?n de perforacio?n septal residual.
 Resultados: la tasa de e?xito de cierre de perforacio?n septal fue de 78,3 %; siendo las etiologi?as ma?s frecuentes antecedente de cirugi?a e idiopa?tica. La complicacio?n ma?s comu?n fue epistaxis en el 26 % de los pacientes, seguida de dolor en el 21,7 % en el postoperatorio mediato, el cual mejoro? en los controles posteriores. Conclusio?n: Los resultados con la te?cnica de cierre de perforacio?n septal con injerto de banco fueron satisfactorios en esta poblacio?n.

Resultados postoperatorios de cierre quirúrgico de perforación septal con injertos de cartílago.

Introduccio?n: Las perforaciones septales y su correccio?n quiru?rgica constituyen un reto para los otorrinolaringo?logos. Se encuentran descritas en la literatura diferentes te?cnicas para el cierre de perforaciones septales; sin embargo, sus resultados en te?rminos de efectividad son muy variables y con pocos pacientes. Desde hace 8 an?os se viene realizando la te?cnica de cierre de perforacio?n septal con injertos de carti?lago en el servicio de otorrinolaringologi?a del Hospital San Jose? y se ha observado una respuesta cli?nica exitosa.
 Objetivo: describir los resultados postoperatorios de los pacientes manejados con la te?cnica de cierre quiru?rgico de perforacio?n septal con injertos de carti?lago, en te?rminos de aparicio?n de complicaciones y frecuencia de perforacio?n septal residual. Disen?o: estudio de tipo cohorte descriptiva.
 Metodologi?a: se describe una cohorte de pacientes manejados con la te?cnica de cierre quiru?rgico de perforacio?n septal con injertos de carti?lago de banco o carti?lago auto?logo. Se incluyeron pacientes a partir de enero de 2014 a junio de 2018. Se extrajeron de la historia cli?nica los datos demogra? cos, cli?nicos, complicaciones y presentacio?n de perforacio?n septal residual.
 Resultados: la tasa de e?xito de cierre de perforacio?n septal fue de 78,3 %; siendo las etiologi?as ma?s frecuentes antecedente de cirugi?a e idiopa?tica. La complicacio?n ma?s comu?n fue epistaxis en el 26 % de los pacientes, seguida de dolor en el 21,7 % en el postoperatorio mediato, el cual mejoro? en los controles posteriores. Conclusio?n: Los resultados con la te?cnica de cierre de perforacio?n septal con injerto de banco fueron satisfactorios en esta poblacio?n.

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

Endoscopic approaches for septal perforation closure have achieved a certain popularity. Many of the flaps described provide unilateral closure of the perforation. Thus, complete restoration of the normal multilayer septal anatomy is still challenging, particularly in children. This article presents a modified technique for endoscopic bilateral surgical repair of nasal septal perforations. A novel cross-septal returned flap was performed in nine patients with nasal septal perforations. The mean size of the perforation was 17.7mm in the sagittal axis and 16.9mm in the vertical axis. All patients were followed up for a minimum of 12 months (range 12–31 months). There was only one case of residual septal perforation during the follow-up period, but with a significant decrease in the severity of symptoms. The results of the surgical technique presented show its high efficacy. We believe that the best indication for this technique is non-epithelized perforation edges that cannot be used as a reliable bridge for the preparation of any cross-over flaps. Use of the cross-septal returned flap allows the complete bilateral repair of nasal septal perforations to be achieved.

Closure of septal perforation using unilateral mucosal advancement flaps

Closure of septal perforation using unilateral mucosal advancement flaps

Endoscopic closure of septal perforation in children with a vascularized flap on the ethmoidal artery

In the article, a new method of septal perforation closing in children with a flap on the ethmoid artery under endoscopic control is described. Unlike conventional endoscopic procedures described technique allows to close the perforation bilaterally. Using the author's technique, 6 children with septal perforation aged from 13 to 17 years (mean age 15.2±2.1) were operated on. In all patients, the perforation was completely closed. Thus, the method has shown high efficiency and safety, which allows it to be widely used in pediatric practice.

Contemporary Trends in the Surgical Management of Nasal Septal Perforations: A Community Survey.

There currently exists an overabundance of publications advocating different septal perforation repair methods. The objective of this article was to examine the preponderance of techniques and trends in the surgical management of septal perforations in the practices of otolaryngologists, rhinologists, and facial plastic surgeons. The study was designed as a multicenter cross-sectional survey. The participants were members of the American Academy of Facial Plastic and Reconstructive Surgery and the American Rhinologic Society. Septal perforation closure rates and perforation repair approach, technique, and interposition graft material preferences were the main outcomes. A total of 320 respondents completed the survey, of whom 75% performed perforation repairs. The success rates in closing perforations < 1 cm, 1-2 cm, and > 2 cm were 84%, 64%, and 31%, respectively. The respondents had a similar preference for the endoscopic (52%) and external rhinoplasty (49%) approaches, followed by the endonasal approach (43%). Bilateral intranasal mucosal advancement flaps (79%) and unilateral intranasal mucosal rotational or advancement flaps (60%) were the favored repair techniques. Most respondents (84%) incorporated an interposition graft and intranasal splints (89%) for the repair, and the most popular interposition graft material was acellular dermis (63%). The self-reported perforation closure success rates in this survey were lower than those published in the literature, a phenomenon possibly explained by the premise that surgeons with favorable outcomes are more apt to share their results. The preferred surgical approach was evenly distributed between the external rhinoplasty and endoscopic approaches and influenced by a surgeon's training, perforation size and location, and the need for concomitant rhinoplasty. This study is the first to characterize contemporary community trends in the surgical closure of septal perforations and demonstrates that while preference for perforation repair approach among the respondents varied, surgeons favored septal perforation repair using bilateral intranasal mucosal advancement flaps with an interposition graft.

Microscopic approach for repairing nasal septal perforations using bilateral advancement flaps.

Septal perforations consist in an anatomic defect of the mucosal, cartilaginous and/or bone tissues of the nasal septum. A huge variety of approaches and techniques for nasal perforation repair have been reported. Between January 2008 and January 2017, 38 patients were treated for nasal septal perforation in Department of Otorhinolaryngology Head and Neck Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain. A novel approach is presented based on microscope. Septal perforation closure was performed with endonasal bilateral advancement flaps-established technique and autologous cartilage and muscle temporal fascia grafts. We performed a retrospective review of closure rates and complications. A postoperative follow-up of at least 12months was performed in 37 patients. The mean size of perforation was 1.33cm. After the withdrawal of the silicone splints, perforations were completely closed in all cases. However, during the follow-up, four patients resulted in a reperforation, so our closure rate was 89.19%. For all cases, symptoms related to septal defect were solved. Only one case was reported of local infections that was resolved with antibiotics in a few days. Microscopic approach of septal perforation closure using bilateral advancement flaps can be an affordable technique with a high percent of success and low rate of complications.

Endoscopic Closure of Septal Perforations

ObjectiveThe management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation. DiscussionInspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations. ConclusionThe remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon.

Use of Costal Perichondrium as an Interpositional Graft for Septal Perforation Closure.

Closure of septal perforations remains a technically difficult procedure to perform. To assess the use of costal perichondrium as an interpositional graft to enhance closure of septal perforations using bilateral mucosal flaps and the effectiveness of the procedure. This case series included all 51 consecutive patients presenting with septal perforations from January 1, 2006, to August 31, 2014, at a single institution. Mean (SD) follow-up was 19 (18) months. Patients with subtotal perforations did not have their perforations closed but underwent rhinoplasty with improved form and function. All patients underwent evaluation for changes in postoperative symptoms. Bipedicled mucoperichondrial flaps with placement of costal perichondrium between the repaired flaps. Success rate of septal perforation closures and the clinical impact of the success of closure as experienced by the patient using the validated Nasal Obstruction Symptom Evaluation (NOSE) questionnaire (range, 0-20; higher scores indicate greater obstruction). Of the 51 patients (14 male; 37 female; median age, 42.6 [range, 17-69] years), 44 underwent attempted closure of the perforation at the time of the procedure. Closure was successful in 42 of the 44 patients (95%).Two patients had persistent perforations, one of which was subsequently closed in a secondary procedure. Twenty-six of 51 patients with septal perforations completed preoperative and postoperative NOSE questionnaires. The mean (SD) preoperative and postoperative NOSE scores were 12.6 (4.2; range, 6-20) and 3.4 (3.8; range, 0-12), respectively (P < .001). A mean (SD) improvement of 9.0 (3.9) points in the NOSE score was observed from patients after closure of their septal perforation, and 10 patients reported no symptoms (NOSE score, 0). Costal perichondrium is an effective interpositional graft to be used in conjunction with the bilateral mucoperichondrial flaps for closure of septal perforations. Costal perichondrium may be used to aid in closure rates of septal perforations. 4.

Surgical rehabilitation in the nasal septum perforation in children

The article presents the results of operations on plastic closure of septal perforation using a developed method in 14 patients aged 6–15 years. The authors performed analysis of etiological factors of the disease and described in details their original method of subtotal perforation closure, adapted for children’s age as well as the specific features of presurgical preparation and postsurgical management.

Long-term Results of Combined Rhinoplasty and Septal Perforation Repair.

Combined rhinoplasty and septal perforation repair is a technically challenging procedure, and few studies have reported the outcomes. To present the long-term surgical results of rhinoplasty with concurrent septal perforation repair. This retrospective study included 17 patients who underwent rhinoplasty with concurrent septal perforation repair at a tertiary academic medical center from March 2005, through March 2015. Patients had a mean postoperative follow-up duration of 50.9 months. The etiology of the deformity, presenting symptoms, perforation size, intraoperative surgical techniques, and complications were analyzed. Final follow-up was completed on March 31, 2015. Postoperative subjective (telephone survey of patient satisfaction) and objective (Objective Rhinoplasty Outcome Score) patient satisfaction and endoscopic nasal cavity examination at the last follow-up. Among the 17 patients (14 men; 3 women; mean [SD] age, 40 [16] years), 12 (71%) had previously undergone septoplasty and/or septorhinoplasty, 4 (24%) had nasal trauma, and 1 (6%) had an unknown cause. The main aesthetic reasons for rhinoplasty were a saddle nose deformity (10 patients [59%]) and deviated nose related to a previous surgery or trauma (5 patients [29%]). The functional reasons for surgery included nasal obstruction (14 patients [82%]) crusting (2 patients [12%]), epistaxis (1 patient [6%]), and whistling (1 patient [6%]). The perforation size varied from 2 to 30 mm, with a mean of 14.3 mm. Surgery was performed through the open rhinoplasty approach. Perforations were first closed with an advancement flap in 6 patients, rotation flap in 6 patients, a combination of both in 4 patients, and a combination of advancement flap and free mucosal graft in 1 patient, with or without interposition grafts. Rhinoplasty was performed with various grafts, maneuvers, and septal reconstruction. Complete closure with symptom relief was achieved in 15 patients (88%). The mean objective score evaluating the rhinoplasty results was 3.4 (on a scale of 0-4, where 3.4 is good to excellent). No serious complications occurred after surgery. Concurrent rhinoplasty and nasal septal perforation repair is a safe and effective option when necessary. The open rhinoplasty approach facilitated septal perforation closure, whereas septal perforation repair did not affect the surgical result of rhinoplasty. 4.

The bony cartilaginous unit: the missing graft in septorhinoplasty

To achieve the desired nasoseptal refinements in septorhinoplasty, sufficient septal cartilage is needed. There are many cases in which septal cartilage is insufficient, especially in revision surgery. To obtain an optimal outcome, a bony cartilaginous unit is proposed as a versatile graft for various parts of the nose. This bony cartilaginous unit is extracted using the open septorhinoplasty approach in which the bilateral septal flaps are elevated over the entire cartilaginous and bony part; however, the cartilaginous septum and posterior bony part are not separated and are removed as an integrated unit. These bony cartilaginous units can be used as various types of grafts at different sites in the nose. In the present study, the bony cartilaginous units were used as caudal extension grafts, spreader grafts, lateral crural strut grafts, and for the closure of septal perforations. This research has shown the advantage of using septal bone in conjunction with cartilage as an integrated unit to correct external nose and septal deformities, especially in cartilage-depleted patients.