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

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.

Contemporary Trends in the Surgical Management of Nasal Septal Perforations: A Community Survey

“…[21][22][23][24] The success rate reported in the literature for the closure of septal perforations of all sizes range from 52 to 100%. [1][2][3]5,8,15,16,20,25 In a systematic review of the literature, Kim and Rhee 26 reported an aggregate successful closure rate of 93% for perforations smaller than 2 cm and 78% for perforations larger than 2 cm. In this current survey, the self-reported success rate for closing perforations smaller than 1 cm, 1 to 2 cm, and larger than 2 cm were 84, 64, and 31%, respectively, numbers far below those cited in the literature.…”

“…Perforations are commonly described in the anterior-posterior dimension or as a diameter of the defect, even though perforations are not uniformly circular. 1 More important considerations are the size of a perforation relative to the septum and the height of a perforation. The height of a perforation is inversely proportional to the residual mucosa above and below a perforation, from which most intranasal mucosal advancement flap techniques recruit mucosa to close the perforation.…”

“…The height of a perforation is inversely proportional to the residual mucosa above and below a perforation, from which most intranasal mucosal advancement flap techniques recruit mucosa to close the perforation. 1,20,22 Theoretically, a perforation can involve almost the length of the septum and still be closed relatively easily if the perforation height is manageable. 1,27 Perforation Repair Approach A surgeon's training background, perforation size and location, and a plan to perform concomitant rhinoplasty may influence the choice of surgical approach during perforation repair.…”

“…1,20,22 Theoretically, a perforation can involve almost the length of the septum and still be closed relatively easily if the perforation height is manageable. 1,27 Perforation Repair Approach A surgeon's training background, perforation size and location, and a plan to perform concomitant rhinoplasty may influence the choice of surgical approach during perforation repair. Naturally, ARS surgeons preferred the endoscopic approach (96%) and FPRS surgeons favored the external rhinoplasty approach (87%).…”

“…Kim and Rhee 26 found in their systematic review that the external rhinoplasty approach was more commonly employed for larger, more posterior, and more challenging perforation repairs. As septal perforations are most frequently iatrogenic, 1,26 patients seeking perforation repair often have additional nasal anatomical derangements that may benefit from functional or cosmetic rhinoplasty in the same surgical setting. In this survey, approximately a third of respondents would consider perform concomitant primary rhinoplasty (37%) or revision rhinoplasty (34%).…”