Comparative analysis of the efficacy of unilateral versus bilateral techniques for nasal septal perforation repair in patients with external nasal deformity

Objective. To compare the efficacy of unilateral and bilateral techniques for nasal septal perforation (NSP) closure using vascularized endonasal flaps in combination with rhinoplasty and to assess patient satisfaction with surgical outcomes.
Material and methods. A retrospective study was conducted on the surgical outcomes of 100 patients with combined NSP and external nasal deformity, divided into two groups: Group 1 (n=50) underwent unilateral NSP closure with a vascularized endonasal flap, and Group 2 (n=50) underwent bilateral closure with a vascularized endonasal flap. Both groups also underwent structural or preservation rhinoplasty. Evaluation included endoscopic examination, SNOT-25 and ROE questionnaires preoperatively and at 14 days, 1, 6, and 12 months postoperatively.
Results. Complete anatomical NSP closure was achieved in 80% of patients in Group 1 and 94% in Group 2 (p=0.034). For perforations <20 mm, the difference between groups was statistically insignificant (84.6% vs. 92%; p>0.05), whereas for perforations ≥20 mm, the bilateral technique showed significantly better outcomes (75% vs. 96%; p<0.05). Both groups demonstrated significant improvement in SNOT-25 and ROE scores (p<0.001), with no substantial intergroup differences.
Conclusions. The bilateral NSP closure technique with a vascularized endonasal flap is more effective for perforations ≥20 mm, while both methods are comparable for smaller perforations. Patient satisfaction with nasal appearance did not depend on the chosen technique. The results confirm the feasibility of effectively combining NSP repair with rhinoplasty. Keywords: nasal septal perforation, rhinoplasty, vascularized flap, SNOT-25, ROE
Conflicts of interest. The authors have no conflicts of interest to declare.
Financing. The research was funded from the authors’ own funds