ObjectivesTo assess the reliability of temporal fascia and bone graft for the closure of septal perforation.Study designProspective longitudinal non-randomized.MethodsThe repair of septal perforation was performed using endonasal dissection; suture of the borders of the perforation on at least one side, and interposition of a graft of temporal fascia with bone, either a perpendicular plate of ethmoid (six) if available or mastoid cortex (three) if not.ResultsAll patients had closure without re-perforation. Eight out of nine patients had complete closure of the perforation (88.8 per cent). These patients had perforations of less than 3 cm in diameter. The ninth patient had a perforation of more than 3 cm diameter (3.5 × 2.5 cm), and obtained a closure of about 80 per cent of the original perforation. The remaining perforation was in the posterior part of the nose. The patient was relieved of his symptoms (crusting and bleeding). This incomplete closure was most probably due to migration of the graft immediately after surgery. There was no morbidity of the donor site or the ear in the mastoid cortex graft group of patients. This is to our knowledge the first report of the use of the mastoid cortex as a graft in septal perforation.ConclusionsWe consider that the graft of temporal fascia with bone is very reliable, and the use of bone ensures closure while avoiding the complications of a lax septum in large perforations. The technique is suitable for perforations up to 2.5 cm diameter. Perforations larger than 3 cm in diameter are more difficult to close, but closure of the anterior part of the perforation will relieve the patient from the most annoying symptoms.

An unusual case of acute purulent thyroiditis in a 45-year-old man forming a large abscess in the left lobe of the thyroid gland is described. It perforated the capsule at the posterior wall of the thyroid, causing extensive retropharyngeal and retrotracheal abscesses. The patient was treated with broad-spectrum antibiotics and surgical excision of the infected tissues. He has remained well one year after the operation.

Anterior septal deviations are very difficult to handle because their location causes valvular obstruction, and any small residual deviation can cause a high degree of obstruction. The commonly performed submucous resection is not a suitable technique to handle this deformity. The maxilla-premaxilla technique offers a better approach. The surgical technique for anterior septal deviation differs from the standard septoplasty in several steps. A modified technique to treat this particular pathology is described in detail. This technique is highly reliable, and simplifies the access to a difficult-to-handle deformity.