Surgical treatment of nasal septal perforations. Our experience

Septal perforations are difficult problems that the otolaryngologist has to solve. In fact, the otolaryngologist has to identify the cause, which in most cases is either iatrogenic or idiopathic, to decide upon the need for surgery, and select the most suitable surgical technique of those currently available, for the case under consideration. All surgical procedures, aimed at repair of nasal septal perforations, are based on two main principles, namely repair using mucosal, mucoperichondrial, and/or mucoperiosteal flaps from the nasal cavity, or with connective tissue autograft, to be interposed between the mucosal flaps. Surgical repair of septal perforation can be carried out using either the "closed technique" or "open technique". The advantage of the former is that it does not leave any external scar. However, drawbacks related to difficulties due to the narrow operating field may be encountered. Many surgeons prefer the "open" technique, as it offers a wider operating field, thus allowing better access to the superior and posterior margins of the perforation (especially in large and/or posterior perforations), and offering binocular vision. The present report focuses on a short critical examination of the various surgical procedures described in the literature, in the attempt to identify, based also on personal experience, the most suitable techniques to repair septal perforations. A novel technique is presented for the surgical treatment of some types of perforations, which has not, so far, been described in the literature.