Method for endoscopic plastic surgery of persistent perforation of the nasal septum

The main reason of low effectiveness of the nasal septum perforations (NSP) surgical treatment is complete or partial necrosis of the graft and the mucous membrane flaps, which is observed in 7–37% of cases. In these cases, it is significantly more difficult to perform repeated reconstructive operations on the nasal septum (NS).

Objective. To increase the effectiveness of surgical treatment of NSP through the development of an optimal surgical method.

Material and methods. In the period from 2016 to 2018, the original method of surgical treatment was performed in 26 patients, the criterion for effectiveness of the method was the absence of reperforation both at the early stage of the postoperative period and during the first year after surgery. The technical result of our proposed method is an increase of the NSP treatment effectiveness due to the use of two flaps of the mucous membrane on the pedicles from one half of the nasal cavity with interposition of temporal autofascia fragment between the flaps. This technical result is achieved by performing a vertical incision with a scalpel along the mucosa of the NS, with distance of 0.5–1.0 cm from the posterior border of the middle nasal concha attachment site projection, while the incision is continued to the bottom of the nasal cavity along the border of the hard and soft palate to the base of the lower concha, then the scalpel is turned parallel to the bottom of the nasal cavity and the incision is continued along the lateral wall to the front end of the lower nasal concha, then the incision is turned perpendicular to the nasal septum and brought to the lower perforation border, and continued to the posterior edge of the perforation and lift up to the nasal dorsum; the mucous membrane is separated under the perichondrium/ periosteum; the isolated flap on the ethmoid arteries is displaced to the perforation area and sutured to the perforation edges; it is proposed to initially obtain the subperichondrium flap from the upper sections of the NS, which will be rotated into the other half of the nose through the upper edge of the NSP. The flap on ethmoid arteries has the size sufficient to close not only the perforation, but also the donor zone of the first flap obtained from the upper sections of the NS; a twice size of the defect temporal autofascia fragment is interposed between the flaps. If there is cartilage in the upper sections of the NS, the rotation of the first flap can be carried out together with mobilized cartilage, which allows to further strengthen the basis of the NS in the perforation zone.

Results. We noted a durable closure of perforation of the nasal septum, as well as the absence of relapse over the next two years in all 26 patients.

Conclusions. The results obtained suggest that the method is physiological and combines the restoration of the anatomical relationships of structures. A technical and economic improvement should be considered in a reduction in the rehabilitation time after surgery, due to less tissue trauma, the safety of the technique, because defect closure by the abovementioned structures together can reduce such postoperative risks as the flotation and trauma to the septal defect closure area. The proposed method made it possible to achieve a result consisting in increasing the effectiveness of the plastic surgery of persistent perforation of the nasal septum. The advantages of the method are simplicity of execution, safety of mobilization of soft tissues, the ability to efficiently form a block of tissues covering the defect and to securely fix it. The resulting clinical effect significantly improves the quality of life of this category of patients. The method can be used to repair traumatic, postoperative and idiopathic perforations of the nasal septum.

Key words: nasal septum perforation, postoperative nasal septum perforation, surgical treatment of nasal septum perforations, endoscopic nasal septum perforation repair.

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study

For citation: Morozov I.I., Grachev N.S. Method for endoscopic plastic surgery of persistent perforation of the nasal septum. Head and neck Russian Journal. 2020;8(2):39–44 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.