Bilateral Versus Unilateral Repair of Nasal Septal Perforation: A Two-Center Retrospective Study

There are two main approaches for nasal septal perforation (NSP) surgery-bilateral and unilateral repair. There are advantages and disadvantages to each of these techniques. At the same time, there is a lack of comparative studies on the effectiveness of these approaches. The study aims to compare the effectiveness of unilateral and bilateral closure of NSP.

A total of 99 patients with symptomatic NSP underwent surgery between 2021 and 2022 and were followed up at two large tertiary centers. The "unilateral closure" group (Group 1, N = 47) utilized an anterior ethmoidal artery (AEA) flap to close the perforations. Group 2 (N = 52) consisted of patients, who underwent bilateral closure of NSP.

Complete closure of the NSP was achieved in 39 of 47 (83%) patients in Group 1 and in 48 of 52 (92.3%) patients in Group 2. There was a trend toward a higher incidence of incomplete defect closure among Group 1 patients when analyzing the subgroups of large (>2 cm) NSP (RR = 2.75 [95% CI: 0.96; 7.87], p = 0.072). There was a statistically significant decrease in SNOT-25 score after surgery in each of the study groups (p < 0.001) with no significant differences between groups (p = 0.51).

The relative advantages of the thin flap are outweighed by the obtained data of higher efficacy of the bilateral technique in large NSP cases. Therefore, in cases of surgical repair of small and medium-sized NSP, the closure rates after single-layer and double-layer closure are comparable.

3 Laryngoscope, 135:1607-1613, 2025.