Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines

In this article, we briefly review the aetiology and symptoms of nasal septal perforations, and focus on a surgical reconstruction technique of which the results were retrospectively studied. The technique described, involves the interposition of a connective tissue graft between differently designed local mucoperichondrial and/or mucoperiosteal flaps on each side of the perforation, thereby preventing opposing suture lines. On one side a rotation/advancement flap is derived from the septum, the nasal floor and lateral nasal wall while in the opposite nasal passage, bipedicled flaps from the septum and nasal floor and/or from the superior septum and under-surface of the upper lateral cartilage are created. Of the 43 patients included in this study, 40 had their perforation permanently closed, while three experienced a non-symptomatic recurrence. We conclude that the use of differently designed, mucoperichondrial or mucoperiosteal bilateral intranasal flaps with non-opposing suture lines, and interposition of Alloderm or autogenous connective tissue with cartilage, especially with adequate exposure through an external approach, can lead to excellent results in the majority of cases.