Nasal septal perforation repair using intranasal rotation and advancement flaps

We aimed to present our experience with and algorithm for septal perforation repair using advancement and rotation flaps.

A retrospective chart review was performed on 14 patients who underwent septal perforation repair. Etiology, perforation size, presenting symptoms, reconstruction methods, combined operation, surgical results, and complications were evaluated.

The mean postoperative follow-up duration was 36 ± 18 months. Among 14 cases, 9 had previous septoplasty or septorhinoplasty and 5 cases suffered from nasal trauma. The perforation sizes varied from 5 to 27 mm, with a 14-mm average. Two cases had multiple perforations. The main symptoms included nasal obstruction, crusting, epistaxis, and whistling. Perforations were repaired using advancement flaps in seven cases or combination of advancement and rotation flaps in seven cases, with or without an interposition graft. Bilateral mucosal closure was accomplished in all cases. Conchal cartilage, remnant septal cartilage, or septal bone was used for an interposition graft. Nine patients had a concurrent rhinoplasty with septal perforation repair. At last follow-up, complete perforation closure was achieved in 12 cases (85.7%). Septal perforation recurred in 2 large perforation cases, which were repaired without interposition grafts. Nasal symptoms disappeared or improved in 13 cases (92.9%). There were no serious complications after surgery.

Combined use of intranasal advancement and rotation flaps is a safe and promising option for surgical repair of moderate to large septal perforation. Bilateral tension-free mucosal closure with an interposition graft is important for the surgical success.