Auricular Perichondrium Graft for Septal Perforation Repair

Abstract

Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

Septal perforation

“…Auricular cartilage that is harvested for concurrent valve or dorsal augmentation surgery can provide a perichondrium graft and avoid a temporal donor site [18] . A review of graft material selection in our bilateral flap repairs found no significant difference between autologous graft application and closure outcomes [17] . Another attempt at closure following a failed repair can be extremely difficult, or impossible.…”

“…Neovascularization of the graft may improve repair healing [12] . Our choice of autologous temporalis fascia, septal cartilage/bone, or auricular perichondrium is influenced by clinical circumstances [17] . The amount of septal cartilage or bone available for interpositional grafting may be insufficient following septoplasty.…”

Repair of Large Nasal Septal Perforations Using the Upper Lateral Cartilage Mucosal Flap

“…Auricular perichondrium was successfully used in the eight patients. 17 Adequate postoperative follow-up time to report outcomes of perforation treatment has not been established. We have noted that patients sense their septal repair stabilizes before the sixth postoperative month.…”

“…We have found the perichondrium on the posterior surface of auricular cartilage, harvested for concurrent nasal valve or aesthetic procedures, provides for a suitable interposition graft. Auricular perichondrium was successfully used in the eight patients 17 …”