Synthetic Grafts to Prevent Nasal Septal Perforation After Bilateral Mucosal Tears During Septal Surgery

BackgroundSeptoplasty is a common cause of nasal septal perforation (NSP), especially when bilateral apposing septal mucosal tears (BATs) occur intraoperatively. While prior studies have largely focused on NSP management once formed, there is limited evidence on how to prevent NSPs should BATs occur during septal surgery.ObjectiveThe purpose of this study was to assess the efficacy of intraseptal synthetic interposition graft (SIG) placement to prevent NSPs following BATs during septal surgery.MethodsA single-institution retrospective cohort study was conducted with adult patients who underwent septoplasty or septorhinoplasty by 2 surgeons. Patients who had BATs intraoperatively had SIGs placed between the septal flaps (cadaveric acellular dermal or porcine collagen grafts). Patients were monitored endoscopically for NSP development at a minimum of 2 months postoperatively.ResultsOf 1132 operative patients between January 2016 and July 2024, 50 patients (4.4%) experienced BATs and had SIGs placed intraoperatively. Of the 50 patients, the median age was 52.7 years, 72.0% were males, and the median follow-up duration was 4.8 months (range: 2.0-85.4). Regarding the SIGs placed, 54.0% were porcine collagen and 46.0% were cadaveric dermis. While 46/50 patients experienced complete mucosalization of their BATs (92.0%), 4 developed NSPs postoperatively (8.0%). Two NSPs occurred within 2 months postoperatively, and 2 were delayed after complete mucosalization. All NSPs occurred following porcine collagen grafts.ConclusionIntraseptal synthetic IP graft placement demonstrated 92% success in preventing NSPs following BATs during septal surgery. Future studies should explore the efficacy of different SIGs at preventing NSPs following BATs during septal surgery.