Download PDF
Facial Plast Surg 2018; 34(03): 298-311
DOI: 10.1055/s-0038-1654675
Rapid Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience

Russell W. H. Kridel
1   Facial Plastic Surgery Associates, Private Practice, Houston, Texas
,
Sean William Delaney
1   Facial Plastic Surgery Associates, Private Practice, Houston, Texas
2   Division of Facial Plastic Surgery, Department of Otorhinolaryngology—Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center in Houston, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
15 May 2018 (online)

    Permissions and Reprints

Abstract

Septal perforation repair and septorhinoplasty (SRP) each present unique surgical challenges. However, in many instances, these procedures may be performed together successfully. In this study, the authors aim to determine the safety and effectiveness of combining primary or revision SRP and septal perforation repair via an open approach. A retrospective review was carried out of all consecutive patients who had SRP and septal perforation repair via an open approach between 1986 and 2017 in the senior author's practice. Perforation closure in surgery and at the patient's last follow-up, resolution of presenting symptoms, cosmetic results, and complications were analyzed. Records for 141 patients who had simultaneous septal perforation repair and SRP via an open approach, with a mean follow-up of 3.24 years, were reviewed. The mean anterior–posterior perforation dimension was 1.41 ± 0.89 cm, and the mean vertical perforation dimension was 1.16 ± 0.59 cm. The most common etiologies for septal perforation were previous SRP (35.4%) and septoplasty (24.1%). An overall 93.6%, perforation closure, 91.1% symptom relief, and 91.2% patient satisfaction with cosmetic results were achieved. Septal perforations under 1.5 cm in height were closed in 96.7% of patients as opposed to 71.4% of patients with perforations 1.5 cm or taller. Minor revision rhinoplasties were performed in 7.0% of patients. Postoperative infections were rare and noted in only two (1.4%) patients. In the largest study of its kind to date, the authors have shown that in experienced hands septal perforation repair may be performed simultaneously with primary or revision SRP via an open approach without compromising the perforation repair outcome. The vertical dimension of a septal perforation and presence of mucosa above and below a perforation are important considerations for the difficulty of a perforation closure, as septal mucosa is recruited from these locations in our technique of four-quadrant intranasal bipedicled mucosal advancement flap closure.

Keywords

nasal septum - rhinoplasty - septoplasty - nasal reconstruction - advancement flap
 

  • References

  • 1 Kridel RWH. Closure of septal perforation. In: Larrabee Jr. WF, Ridgway J. . eds. Master Techniques in Otolaryngology-Head and Neck Surgery: Facial Plastic Surgery. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2017
    Google Scholar
  • 2 Li L, Han D, Zhang L. , et al. Impact of nasal septal perforations of varying sizes and locations on the warming function of the nasal cavity: A computational fluid-dynamics analysis of 5 cases. Ear Nose Throat J 2016; 95 (09) E9-E14
    PubMedGoogle Scholar
  • 3 Cannon DE, Frank DO, Kimbell JS, Poetker DM, Rhee JS. Modeling nasal physiology changes due to septal perforations. Otolaryngol Head Neck Surg 2013; 148 (03) 513-518
    CrossrefPubMedGoogle Scholar
  • 4 Kridel RWH, Undavia S. Septal perforations. In: Stilianos Kountakis, ed. Encyclopedia of Otolaryngology, Head and Neck Surgery. Berlin, Germany: Springer; 2014
    Google Scholar
  • 5 Kridel RWH. Considerations in the etiology, treatment, and repair of septal perforations. Facial Plast Surg Clin North Am 2004; 12 (04) 435-450 , vi
    Google Scholar
  • 6 Pedroza F, Patrocinio LG, Arevalo O. A review of 25-year experience of nasal septal perforation repair. Arch Facial Plast Surg 2007; 9 (01) 12-18
    Google Scholar
  • 7 Ribeiro JS, da Silva GS. Technical advances in the correction of septal perforation associated with closed rhinoplasty. Arch Facial Plast Surg 2007; 9 (05) 321-327
    PubMedGoogle Scholar
  • 8 Kridel RWH, Appling WD, Wright WK. Septal perforation closure utilizing the external septorhinoplasty approach. Arch Otolaryngol Head Neck Surg 1986; 112 (02) 168-172
    CrossrefPubMedGoogle Scholar
  • 9 Kridel RWH. Combined septal perforation repair with revision rhinoplasty. Facial Plast Surg Clin North Am 1995; 3 (04) 459-472
    PubMedGoogle Scholar
  • 10 Baker SR, Graney DO. Anatomy of the face. In: Flint P. , ed. Cummings Otolaryngology Head and Neck Surgery. 3rd ed. Philadelphia, PA: Elsevier; 1997
    Google Scholar
  • 11 Fairbanks DN, Fairbanks GR. Nasal septal perforation repair: 25-year experience with the flap and graft technique. Am J Cosmet Surg 1994; 11: 189-194
    CrossrefPubMedGoogle Scholar
  • 12 Kridel RWH, Foda H, Lunde KC. Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg 1998; 124 (01) 73-78
    CrossrefPubMedGoogle Scholar
  • 13 Kridel RWH, Foda H. Septal perforations. Facial Plastic and Reconstructive Surgery, 4th ed. New York, NY: Thieme Medical Publishers; 2016: 568-578
    Google Scholar
  • 14 Burstein DH, Kridel RWH. Importance of mucosal closure in nasal septal perforation repair. JAMA Facial Plast Surg 2013; 15 (04) 322-323
    CrossrefPubMedGoogle Scholar
  • 15 Rodman R, Kridel R. A staging system for revision rhinoplasty: A review. JAMA Facial Plast Surg 2016; 18 (04) 305-311
    CrossrefPubMedGoogle Scholar
  • 16 Fairbanks DN. Closure of nasal septal perforations. Arch Otolaryngol 1980; 106 (08) 509-513
    CrossrefPubMedGoogle Scholar
  • 17 Cassano M. Endoscopic repair of nasal septal perforation. Acta Otorhinolaryngol Ital 2017; 37 (06) 486-492 . Doi: 10.14639/0392-100X-1313
    CrossrefPubMedGoogle Scholar
  • 18 Fairbanks DN, Fairbanks GR. Surgical management of large nasal septum perforations. Br J Plast Surg 1971; 24 (04) 382-387
    CrossrefPubMedGoogle Scholar
  • 19 Tardy Jr ME. “Practical suggestions on facial plastic surgery—how I do it.” Sublabial mucosal flap: repair of septal perforations. Laryngoscope 1977; 87 (02) 275-278
    PubMedGoogle Scholar
  • 20 Heller JB, Gabbay JS, Trussler A, Heller MM, Bradley JP. Repair of large nasal septal perforations using facial artery musculomucosal (FAMM) flap. Ann Plast Surg 2005; 55 (05) 456-459
    CrossrefPubMedGoogle Scholar
  • 21 Williams R, Lee MK, Most SP. Large septal perforation repair with pericranial flap and intraoperative fluorescence angiography. Craniomaxillofac Trauma Reconstr 2016; 9 (02) 181-184
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Murrell GL, Karakla DW, Messa A. Free flap repair of septal perforation. Plast Reconstr Surg 1998; 102 (03) 818-821
    CrossrefPubMedGoogle Scholar
  • 23 Friedman M, Ibrahim H, Ramakrishnan V. Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 2003; 113 (08) 1425-1428
    CrossrefPubMedGoogle Scholar
  • 24 Kim SW, Rhee CS. Nasal septal perforation repair: Predictive factors and systematic review of the literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (01) 58-65
    Google Scholar
  • 25 Tardy Jr ME, Cheng EY, Jernstrom V. Misadventures in nasal tip surgery. Analysis and repair. Otolaryngol Clin North Am 1987; 20 (04) 797-823
    CrossrefPubMedGoogle Scholar
  • 26 Tardy ME. Rhinoplasty: The Art and the Science. Philadelphia, PA: WB Saunders; 1997
    Google Scholar
  • 27 Kamer FM, Pieper PG. Revision rhinoplasty. In: Bailey B. , ed. Head and Neck Surgery Otolaryngology. Philadelphia, PA: Lippincott; 1998
    Google Scholar
  • 28 Rees TD. Postoperative considerations and complications. In: Rees TD. , ed. Aesthetic Plastic Surgery. Philadelphia, PA: WB Saunders; 1980
    Google Scholar
  • 29 McKinney P, Cook JQ. A critical evaluation of 200 rhinoplasties. Ann Plast Surg 1981; 7 (05) 357-361
    CrossrefPubMedGoogle Scholar
  • 30 Thomas JR, Tardy Jr ME. Complications of rhinoplasty. Ear Nose Throat J 1986; 65 (01) 19-34
    PubMedGoogle Scholar
  • 31 Becker DG. Complications in rhinoplasty. In: Facial Plastic and Reconstructive Surgery, 2nd ed. New York, NY: Theime; 2009
    Google Scholar
  • 32 Kamer FM, McQuown SA. Revision rhinoplasty. Analysis and treatment. Arch Otolaryngol Head Neck Surg 1988; 114 (03) 257-266
    CrossrefPubMedGoogle Scholar
  • 33 Foda HMT, Magdy EA. Combining rhinoplasty with septal perforation repair. Facial Plast Surg 2006; 22 (04) 281-288
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Hong SN, Mutsumay S, Jin HR. Long-term results of combined rhinoplasty and septal perforation repair. JAMA Facial Plast Surg 2016; 18 (06) 475-480
    CrossrefPubMedGoogle Scholar