Combining Rhinoplasty with Septal Perforation Repair

ABSTRACT

A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair.

KEYWORDS

Nasal septum - septal perforation - external rhinoplasty

REFERENCES

• 1 Belmont J R. An approach to large nasoseptal perforations and attendant deformity.  Arch Otolaryngol. 1985;  111 450-455
• 2 Goldsmith M M. Nasal septal perforations. In: Papel ID, Nachlas NE Facial Plastic and Reconstructive Surgery. 1st ed. St. Louis, MO; Mosby-Year Book 1992: 344-349
• 3 Brain D J. The nasal septum. In: Kerr AG Scott-Brown's Otolaryngology. 6th ed. Oxford, UK; Butterworth-Heinemann 1997: 1-27
• 4 Kridel R W, Foda H M. Nasal septal perforation: prevention, management, and repair. In: Papel ID, Frodel J, Holt GR et al Facial Plastic and Reconstructive Surgery. 2nd ed. New York; Thieme Medical Publishers 2002: 473-484
• 5 Nolst Trenite G J, Verwoerd C D, Verwoerd-Verhoef H L. Reimplantation of autologous septal cartilage in the growing nasal septum.  Rhinology. 1987;  25 225-236
• 6 Gollom J. Perforation of the nasal septum: the reverse flap technique.  Arch Otolaryngol. 1968;  88 518-522
• 7 Fairbanks D N, Fairbanks G R. Nasal septal perforation: prevention and management.  Ann Plast Surg. 1980;  5 452-457
• 8 Kridel R W, Appling W D, Wright W K. Surgical perforation closure utilizing the external septorhinoplasty approach.  Arch Otolaryngol Head Neck Surg. 1986;  112 168-172
• 9 Fairbanks D N, Chen S C. Closure of large nasal septal perforations.  Arch Otolaryngol. 1970;  91 403-406
• 10 Fairbanks D N. Closure of nasal septal perforations.  Arch Otolaryngol. 1980;  106 509-513
• 11 Younger R, Blokmanis A. Nasal septal perforations.  J Otolaryngol. 1985;  14 125-131
• 12 Arnstein D P, Berke G S. Surgical considerations in the open rhinoplasty approach to closure of septal perforations.  Arch Otolaryngol Head Neck Surg. 1989;  115 435-438
• 13 Kratz R C. Repair of septal perforation with composite grafts.  Arch Otolaryngol. 1973;  98 380-384
• 14 Strelzow V V, Goodman W S. Nasoseptal perforation-closure by external septorhinoplasty.  J Otolaryngol. 1978;  7 43-48
• 15 Foda H MT. The one-stage rhinoplasty septal perforation repair.  J Laryngol Otol. 1999;  113 728-733
• 16 Foda H M. The one-stage endoscopic septal perforation repair and rhinoplasty. Presented at the American Academy of Facial Plastic and Reconstructive Surgery Fall Meeting; September 23-25. 1999 New Orleans, LA;
• 17 Foda H MT. External rhinoplasty: a critical analysis of 500 cases.  J Laryngol Otol. 2003;  117 473-477
• 18 Foda H MT. External rhinoplasty for the Arabian nose: a columellar scar analysis.  Aesthetic Plast Surg. 2004;  28 312-316
• 19 Foda H MT. The role of septal surgery in management of the deviated nose.  Plast Reconstr Surg. 2005;  115 406-415
• 20 Foda H M, Bassyouni K. Rhinoplasty in the unilateral cleft lip nasal deformity.  J Laryngol Otol. 2000;  114 189-193
• 21 Foda H MT. Rhinoplasty for the multiply revised nose.  Am J Otolaryngol. 2005;  26 28-34
• 22 Foda H M. Mersiline mesh in premaxillary augmentation.  Aesthetic Plast Surg. 2005;  29 169-173
• 23 Goodman W S, Strelzow V V. The surgical closure of nasoseptal perforations.  Laryngoscope. 1982;  92 121-124
• 24 Wright W K. Closure of large septal perforations.  Arch Otolaryngol. 1970;  91 492-493
• 25 Raman R. Closure of large septal perforations.  Laryngoscope. 1990;  100 789-790
• 26 Kridel R W, Foda H M, Lunde K C. Septal perforation repair with acellular human dermal allograft.  Arch Otolaryngol Head Neck Surg. 1998;  124 73-78