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

2018 ◽  
Vol 33 (3) ◽  
pp. 256-262 ◽  
Author(s):  
Marina N. Cavada ◽  
Carolyn A. Orgain ◽  
Raquel Alvarado ◽  
Raymond Sacks ◽  
Richard J. Harvey
Keyword(s):  
Corticosteroid Injection ◽  
Case Series ◽  
Collagen Matrix ◽  
Contralateral Side ◽  
Septal Perforation ◽  
Closure Rate ◽  
Reliable Technique ◽  
Nasal Septal Perforation ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

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

2021 ◽  
pp. 194589242110121
Author(s):  
Jacopo Zocchi ◽  
Federico Russo ◽  
Luca Volpi ◽  
Hassan Ahmed Elhassan ◽  
Giacomo Pietrobon ◽  
...  
Keyword(s):  
Demographic Data ◽  
Case Series ◽  
Standard Technique ◽  
Minimal Invasive ◽  
Invasive Technique ◽  
Closure Rate ◽  
Lower Success Rate ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

Background Nasoseptal perforation repair is a challenging condition with no standard technique for repair recognized. Methods A case series of consecutive patients who underwent nasoseptal perforation repair with an anterior ethmoidal artery flap was conducted. Demographic data, preoperative features of the perforation and postoperative outcomes were analyzed. Closure rate, complications and persistence of nasal symptoms were documented. Results Thirty-two patients were included in the study. The average perforation diameter was 1.48 cm (range: 0.4–3 cm). Iatrogenic trauma was the most common cause (56% of patients). Nine cases ended up being idiopathic. The overall closure rate was 81%, but 87.5% when perforation had a 2-cm diameter or less. Of the six failures, 2 were due to flap necrosis and 4 to a residual anterior perforation. Despite the persistence, 2 patients solved their symptoms. One patient underwent revision surgery. Conclusion The anterior ethmoidal artery flap is a reliable and minimal invasive technique for closure of symptomatic perforations. For defects larger than 2 cm, a lower success rate and additional reconstructive measures should be considered. Objective questionnaires are needed in order to evaluate functional outcomes.

Nasal Septal Perforation Closure by “Sandwich Grafts”: Technique, Initial Results

2021 ◽  
Author(s):  
Mattis Bertlich ◽  
Friedrich Ihler ◽  
Maya Bertlich ◽  
Mark Jakob ◽  
Martin Canis ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Case Series ◽  
Septal Perforation ◽  
Auricular Cartilage ◽  
Reliable Technique ◽  
Temporal Fascia ◽  
Nasal Septal Perforation ◽  
Foreign Materials ◽  
Septal Perforations ◽  
Initial Results

AbstractNasal 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.

Perioperative Management of Nasal Septal Perforation: A Case Series and Review

2021 ◽  
Author(s):  
William James Wakeford ◽  
Eamon Shamil ◽  
Alwyn Ray D'Souza
Keyword(s):  
Patient Selection ◽  
Surgical Techniques ◽  
Case Series ◽  
Postoperative Management ◽  
Good Effect ◽  
Septal Perforation ◽  
Closure Rate ◽  
Surgical Closure ◽  
Clear Cut ◽  
Nasal Septal Perforation

AbstractNasal septal perforation is a prevalent pathology, and its successful treatment remains a significant challenge. Surgical closure is complex, and there are a plethora of accounts of various surgical techniques within the existing literature. Much less has been written about perioperative considerations, which are arguably just as important. This article therefore focuses predominantly on the pre and postoperative management of patients with septal perforation. By drawing both on the existing literature and a series of 64 cases managed over several years by our department, this review aims to consolidate guidance on patient selection, timing of surgical intervention, postoperative splinting, use of antibiotics, and patient advice. It is clear that the size of the perforation (relative to the size of the septum), health of surrounding mucosa, and the systemic health and age of the patient remain essential considerations in patient selection and operative timing. Internal and external splints are widely used to good effect, but the role of nasal packing is less clear-cut. This article suggests packing, but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin paste). Use of prophylactic antibiotics remains controversial. The complete closure rate for the series presented here was 81.3%, with an average perforation diameter of 15.1 mm (range: of 6–32 mm), and that for perforations with a diameter below 22 mm was 97.9%.

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.

Anterior Ethmoidal Artery Septal Flap for the Management of Septal Perforation

2011 ◽  
Vol 13 (6) ◽  
pp. 411-414
Author(s):  
Paola Castelnuovo ◽  
Fabio Ferreli ◽  
Iman Khodaei ◽  
Pietro Palma
Keyword(s):  
Septal Perforation ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

scholarly journals Nasal Septal Perforation: Experience of Management

2021 ◽  
Vol 28 (3) ◽  
pp. 255-259
Author(s):  
Selçuk Kuzu ◽  
Çağlar Günebakan
Keyword(s):  
Nasal Septum ◽  
Inflammatory Diseases ◽  
Nasotracheal Intubation ◽  
Septal Perforation ◽  
Closure Rate ◽  
Composite Tissue ◽  
Nasal Septal Perforation ◽  
Common Causes ◽  
Septum Perforation ◽  
Nasal Septum Perforation

Introduction Nasal septal perforation is the loss of composite tissue comprising the mucosa, bone or cartilage structures that form the nasal septum. Nasal septum perforation has many causes. Though it may be idiopathic, the most common causes are iatrogenic like nasal surgeries. Among other reasons are septal hematoma, nasal picking habit, nasal cauterization due to nosebleeds, nasotracheal intubation, cocaine use, vasculitis, inflammatory diseases such as sarcoidosis, This study aims to review the approach to management of patients with nasal septal perforation who underwent repair of the perforation in a tertiary clinic, in the light of current literature. Materials and Methods In this study, the records of 27 patients who were diagnosed with nasal septal perforation and treated surgically in a tertiary clinic, between January 2015 and June 2019 were reviewed retrospectively. Results The successful closure rate of perforations was 74%. In 4 of 7 patients whose perforations were not completely closed, the perforation size was larger than 2 cm in diameter. Conclusion Successful repair of nasal septal perforation depends largely on the cause, location, size of the perforation, cartilage bone tissue on the perforation edges, surgical technique and the surgeon's experience.

Sign in / Sign up

Export Citation Format

Share Document