Concomitant Rhinoplasty and Septal Perforation Repair

2020 ◽  
Vol 36 (01) ◽  
pp. 078-083 ◽  
Author(s):  
Russell W.H. Kridel ◽  
Sean W. Delaney
Keyword(s):  
Nasal Obstruction ◽  
Septal Perforation ◽  
Septal Surgery ◽  
Septal Perforations

AbstractThe rhinoplasty surgeon may encounter nasal septal perforations (NSPs) during the examination of the prospective rhinoplasty candidate, many of whom have had prior septal surgery. While small NSPs may be asymptomatic, larger NSPs may cause nasal obstruction, crusting, bleeding, or external nasal deformities. Septal perforation repair and rhinoplasty can be safely and effectively performed simultaneously for the appropriate surgical candidate. In this article, we review the important considerations when determining the surgical candidacy for concomitant rhinoplasty and septal perforation repair.

Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series

2020 ◽  
pp. 000348942097059
Author(s):  
Benjamin G. Hunter
Keyword(s):  
Nasal Obstruction ◽  
Surgical Repair ◽  
Case Series ◽  
Collagen Matrix ◽  
Septal Perforation ◽  
Surgical Success ◽  
Interposition Graft ◽  
Patient Reported ◽  
Septal Perforations ◽  
Porcine Collagen

Objective: Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain. Method: The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms. Results: Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic. Conclusions: This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.

Auricular Perichondrium Graft for Septal Perforation Repair

2021 ◽  
pp. 000348942110157
Author(s):  
Stephen F. Bansberg ◽  
Cullen M. Taylor ◽  
Gregory S. Neel
Keyword(s):  
Nasal Obstruction ◽  
Graft Material ◽  
Septal Perforation ◽  
Nasal Valve ◽  
Auricular Cartilage ◽  
Interposition Graft ◽  
Presenting Symptoms ◽  
Septal Surgery ◽  
Record Review

Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

Assessing Patient Symptoms Due to Nasal Septal Perforation: Development and Validation of the NOSE-Perf Scale

2021 ◽  
pp. 019459982199201
Author(s):  
Cullen M. Taylor ◽  
Stephen F. Bansberg ◽  
Michael J. Marino
Keyword(s):  
Nasal Obstruction ◽  
Discriminant Validity ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Control Group ◽  
Septal Perforation ◽  
Specific Symptom ◽  
Nose Scale ◽  
Nasal Septal Perforation ◽  
Patient Reported

Objective Reporting patient symptoms due to nasal septal perforation (NSP) has been hindered by the lack of a validated disease-specific symptom score. The purpose of this study was to develop and validate an instrument for assessing patient-reported symptoms related to NSP. Study Design Validation study. Setting A tertiary care center. Methods The Nasal Obstruction Symptom Evaluation (NOSE) scale was used as an initial construct to which 7 nonobstruction questions were added to measure septal perforation symptoms. The proposed NOSE-Perf instrument was distributed to consecutive patients evaluated for NSP, those with nasal obstruction without NSP, and a control group without rhinologic complaints. Questionnaires were redistributed to the subgroup with NSP prior to treatment of the perforation. Results The study instrument was completed by 31 patients with NSP, 17 with only nasal obstruction, and 22 without rhinologic complaint. Internal consistency was high throughout the entire instrument (Cronbach α = 0.935; 95% CI, 0.905-0.954). Test-retest reliability was demonstrated by very strong correlation between questionnaires completed by the same patient at least 1 week apart ( r = 0.898, P < .001). Discriminant validity was confirmed via a receiver operating characteristic ( P < .001, area under the curve = 0.700). The NOSE-Perf scale was able to distinguish among all 3 study groups ( P < .001) and between NSP and nasal obstruction ( P = .024). When used alone, the NOSE scale could not discriminate between NSP and nasal obstruction ( P = .545). Conclusions The NOSE-Perf scale is a validated and reliable clinical assessment tool that can be applied to adult patients with NSP.

Effect of Septal Perforations on Measures of Nasal Resistance

1997 ◽  
Vol 34 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Thomas W. Guyette ◽  
Bonnie E. Smith
Keyword(s):  
Outcome Measures ◽  
Repeated Measures ◽  
Dependent Measure ◽  
Nasal Resistance ◽  
Septal Perforation ◽  
Analog Model ◽  
Repeated Measures Anova ◽  
Nominal Scale ◽  
Independent Variables ◽  
Septal Perforations

Objective The purpose of this investigation was to determine the effect of septal perforations on posterior and anterior rhinomanometric measures of nasal resistance In an analog model. Design The data were analyzed using a repeated-measures ANOVA. Nasal resistance was the dependent variable, while type of rhinomanometry, septal perforation size, and position of resistance (proximal vs. distal) were nominal scale independent variables. Participants The analog model used in this study was similar to that described by Warren and Devereux (1966), except that the nasal cavities of the model were modified to create septal perforations. Outcome Measures The main dependent measure was nasal resistance. Results An important finding of this investigation was that septal perforations resulted in large differences (> 3 cm H2O/L/sec) between posterior and anterior nasal resistance values in the bilateral proximal resistor condition. Conclusions Anterior rhinomanometry may underestimate true nasal resistance when a septal perforation Is present, because the septal perforation prevents accurate measurement of nasopharyngeal pressure. Posterior rhinomanometric measures should accurately reflect nasal resistance despite septal perforations, because the perforation does not invalidate the estimate of nasopharyngeal pressure.

The results of septal button insertion in the management of nasal septal perforation

1999 ◽  
Vol 113 (9) ◽  
pp. 823-824 ◽  
Author(s):  
Üstün Osma ◽  
Sebahattin Cüreoǧlu ◽  
Nursel Akbulut ◽  
Faruk Meriç ◽  
Ismail Topçu
Keyword(s):  
Nasal Obstruction ◽  
Septal Perforation ◽  
Nasal Septal Perforation

AbstractNasal septal perforation may present with various symptoms. Perforations may be surgically closed or managed by obturation, inserting a prosthesis. We used a silicon septal button in the management of nasal septal perforation. In the follow-up period, although the insertion of the nasal septal button alleviated epistaxis, whistling during inspiration, and nasal obstruction, it could not control the production of crusting around the margin of the button.

Asymptomatic Nasal Septal Perforations in Systemic Lupus Erythematosus

1980 ◽  
Vol 89 (1) ◽  
pp. 78-80 ◽  
Author(s):  
David Reiter ◽  
Allen R. Myers
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Common Phenomenon ◽  
Septal Perforation ◽  
Systemic Lupus ◽  
Clinical Correlates ◽  
Nasal Septal Perforation ◽  
Diagnostic Criterion ◽  
Septal Perforations

Nasal septal perforation has been considered a diagnostic criterion for systemic lupus erythematosus since 1971. However, little has been published in the otorhinolaryngologic literature regarding this lesion. We report six patients having asymptomatic anteroinferior nasal septal perforations and symptomatic lupus. No obvious clinical correlates were found. We support the hypothesis that nasal septal perforation in systemic lupus erythematosus is a common phenomenon, and attribute its infrequent detection to the asymptomatic nature of the lesion in this setting.

Repair of Nasal Septal Perforation

1997 ◽  
Vol 11 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Mohammed Yousef-Mian
Keyword(s):  
Success Rate ◽  
Double Layer ◽  
The Other ◽  
Septal Perforation ◽  
Current Analysis ◽  
Operative Techniques ◽  
Nasal Septal Perforation ◽  
Novel Method ◽  
Incomplete Closure ◽  
Septal Perforations

The management of nasal septal perforation remains unsatisfactory. Various operative techniques have been described, with modest success. A novel method for repair of septal perforations up to 2.6 cm in diameter was investigated. A double layer closure of nasal septal perforation was designed, one with the cartilage and the other by a flap based on the anterior septal branches of the sphenopalatine artery. Fourteen patients have been operated upon. The current analysis reveals a success rate of 13 patients (93%) who had complete closure and one patient (7%) with incomplete closure. The operative techniques and results are reported here.

Closure of Nasal Septal Perforations with a Polydioxanone Plate and Temporoparietal Fascia in a Closed Approach

2017 ◽  
Vol 31 (3) ◽  
pp. 190-195 ◽  
Author(s):  
Lorenz Epprecht ◽  
Christoph Schlegel ◽  
David Holzmann ◽  
Michael Soyka ◽  
Thomas Kaufmann
Keyword(s):  
Case Series ◽  
Invasive Technique ◽  
Flexible Plate ◽  
Open Approach ◽  
Septal Perforation ◽  
Temporoparietal Fascia ◽  
Closed Approach ◽  
First Time ◽  
Septal Perforations

Background Septal perforation closure is still often invasive and complex, with relatively low closure rates. Objectives 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. Methods 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. Results 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. Conclusion 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.

Sarcoidosis with Nasal Obstruction and Septal Perforation

1998 ◽  
Vol 77 (11) ◽  
pp. 896-902 ◽  
Author(s):  
Eric D. Baum ◽  
Alan C. Boudousquie ◽  
Shiyong Li ◽  
Natasha Mirza
Keyword(s):  
Nasal Obstruction ◽  
Septal Perforation
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