Good results after endonasal cartilage closure of nasal septal perforations

Surgical closure of nasal septal perforations is a challenging procedure. Several approaches and techniques have been described with different levels of success. We report our experience in nasal septal perforation surgery.

We reviewed a sample of 19 patients who underwent surgical closure of nasal septal perforations. The perforations varied in size from 3 mm to 25 mm (mean 13 mm). Outcome was assessed on the basis of a comparison of the preoperative and final follow-up assessment of perforation size and symptoms. The surgical technique is based on an endonasal approach with dissection of bilateral bipedicled mucoperichondrial/-periosteal advancement flaps and interposition of a septal or conchal cartilage graft.

Symptomatic resolution was documented for 18 of the 19 patients (95%). Complete closure was accomplished in 16 patients (84%) without major complications. We observed no graft donor site morbidity.

The technique described uses recognized surgical principles to reconstruct the original nasal architecture and physiology. The results achieved sustain that the method offers both durability and strength. The endonasal approach leaves no scars, reduces risk of tip-rotation and offers sufficient view and space for instrumentation. We conclude that this method is suitable for treatment of perforations up to a vertical height of at least 25 mm.