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Published on: June 20, 2018
Endoscopic repair of septal perforation in children
Yury Rusetsky1, Zhanna Mokoyan2, Irina Meytel1
1Federal State Autonomous Institution "National Medical Research Center of Children Health". Moscow, Lomonosov Avenue, 2, 119991, Russia.
Insights
Surgical repair of pediatric nasal septal perforations is effective, with endoscopic techniques achieving nearly 100% symptom reduction. Specialized flaps, like the anterior ethmoidal artery flap combined with the inverted edges technique, showed the best closure rates.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Rhinology
Background:
- Pediatric nasal septal perforations present a surgical challenge with limited literature.
- Effective management strategies are crucial for improving children's quality of life.
Purpose of the Study:
- To evaluate diverse surgical techniques for pediatric septal perforation repair.
- To introduce and assess two novel endoscopic approaches: the inverted edges technique and the cross-septal returned flap.
Main Methods:
- Operated on 24 pediatric patients (ages 6-17) using various endoscopic techniques.
- Included established methods (e.g., anterior ethmoidal artery flap) and two original techniques.
Main Results:
- Achieved an overall complete perforation closure rate of 79% (19/24 patients).
- Symptom reduction efficacy approached 100%.
- The inverted edges technique combined with the anterior ethmoidal artery flap yielded the highest success rate with no reperforations in 10 cases.
Conclusions:
- Endoscopic assistance, vascularized mucoperichondrial flaps, and bilateral closure are highly effective for pediatric septal perforation repair.
- Novel techniques demonstrate promising results in managing these challenging perforations.
Objective:
Being increasingly faced with the problem of pediatric nasal septal perforations, we have found that the surgical management of nasal septal perforations in children is not widely described in the litrature. The objective of our study was to demonstrate the results of different surgical techniques, including two original endoscopic techniques, in the septal perforation repair in children.
Methods:
24 children, ranging between 6 and 17 years of age, with nasal septal perforations were operated using different endoscopic techniques from February 2015 to May 2019 at the special tertiary referral clinic. Apart from well-known techniques, such as anterior ethmoidal artery flap, intranasal bipedicled advancement flap, sublabial flap, free temporal fascia graft, we used two original techniques - inverted edges technique and cross-septal returned flap.
Results:
The total rate of complete perforation closure was 79% (19 of 24 patients). Regarding the reduction of symptoms, the efficacy of surgery was approaching 100%. The combination of inverted edges technique and anterior ethmoidal artery septal flap demonstrated the best results with no reperforations in all 10 cases. Using cross-septal returned flap, we achieved complete closure of perforation in 5 (83%) of 6 patients. The remaining techniques were performed rare and showed relatively low rates of success. There were 2 cases of complications (oronasal fistula), both developed in patients with sublabial mucosal flap.
Conclusion:
Use of endoscopic assistance, vascularized mucoperichondrial flaps and bilateral closure demonstrates high effectiveness in septal perforation surgical repair in children.
Level Of Evidence:
4.
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