Upper lateral cartilage composite flap for closure of complicated septal perforations

Dl, Smith; Albathi, Monirah; Lee, Andrew; Lee, Linda N.; Boahene, Kofi

doi:10.1002/lary.26520

Cited by 6 publications

(7 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7,9 Endoscopic approaches are beneficial due to the absence of an external scar, optimal exposure of the surgical field with endoscopes, and close control of perforation margins. 1,6 Previous reports have yielded variable results, suggesting endoscopic closure rates from 76.4% to 100%. [2][3][4]7,[9][10][11][12][13] Despite the concern that an endoscopic view may result in decreased flap mobilization or inadequate tissue approximation, 1 the current series describes a technique without compromising the mobility or viability of the flap.…”

Section: Discussionmentioning

confidence: 99%

“…Nasal septal perforations (NSPs) are a complete anatomic defect of the nasal septum incorporating the mucosa as well as the cartilaginous or osteocartilaginous septum. [1][2][3] In the literature, perforations have been typically classified as small ( 0.5 cm), medium (0.5-2 cm), and large (>2 cm), 1,4 but there is no general consensus in categorizing the size and location of NSPs. Many etiologies can lead to a perforation including local trauma, chondritis, inhalant irritants, septal hematoma, infection, neoplasms, substance abuse, iatrogenic causes, and autoimmune diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Many etiologies can lead to a perforation including local trauma, chondritis, inhalant irritants, septal hematoma, infection, neoplasms, substance abuse, iatrogenic causes, and autoimmune diseases. [1][2][3]5,6 Iatrogenic causes, such as complications from routine procedures such as septoplasty, are considered the most common cause of NSP. 2,7,8 The symptoms vary in intensity from mild to severe and can greatly affect quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Patients may also report dryness, crusting, whistling, discharge, epistaxis, nasal obstruction, pain, and cosmetic deformity. [1][2][3][4]6,7 Although posterior perforations are usually asymptomatic, 7 crusting is the most common complaint. 2 Nonsurgical management of NSP is aimed at symptomatic control and includes the use of saline irrigation, application of emollients, and placement of silicone button prostheses.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix

Cavada

Orgain

Alvarado

et al. 2018

Am J Rhinol�Allergy

View full text Add to dashboard Cite

Background Nasal septal perforation repair remains a challenge with no standard technique for repair recognized. Objective To describe the combination of an anterior ethmoidal artery flap with a collagen matrix inlay as a successful technique for nasal septal perforation repair. Methods A case series of consecutive patients who underwent nasal septal perforation repair with an anterior ethmoidal artery flap with an inlay collagen graft was conducted. Demographic data, preoperative features of the perforation (size, location, and presence of chondritis), and postoperative outcomes were analyzed; closure rate, mucosalization rate (of the contralateral side at 21 and 90 days), and complications (crusting, bleeding, obstruction, infection, and rehospitalization <30 days) were documented. Results Thirteen patients (age: 49 ± 15 years, 30.8% women) were assessed. The perforation size was 1.6 ± 0.9 cm (range: 0.3–3.5 cm) and located 1.2 ± 0.5 cm (range: 0.5–2.0 cm) posterior to the columella. Chondritis was present in 69.2%. The closure rate was 100% (95% confidence interval [CI]: 77%–100%) at both 21 and 90 days. One patient required a free mucosa graft to an area of persistent crusting on the contralateral side (7.7%). Complications were low; bleeding 0%, obstruction 7.7% (requiring corticosteroid injection of anterior ethmoidal artery flap), and 0% infection/rehospitalization. Conclusion Anterior ethmoidal artery flap with an inlay collagen matrix is a reliable technique to repair nasal septal perforation. This technique, with robust vascularity and wide angle of rotation, enables the closure of perforations both large (<50% total septum) and with anterior locations.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix

Cavada

Orgain

Alvarado

et al. 2018

Am J Rhinol�Allergy

View full text Add to dashboard Cite

show abstract

“…Interposition of different grafts were also used with the local flaps including acellular human dermal grafts [11] , temporalis fascia [12,22] and cartilage grafts including Split Septal Cartilage Graft [13] , conchal cartilage [14,15,22] , composite conchal cartilage graft [16] and Upper Lateral Cartilage Flap [17] .…”

Section: Introductionmentioning

confidence: 99%

Use of Butterfly Composite Conchal Cartilage Graft with Local Posteriorly Pedicled Flap in Repair of Nasal Septum Perforations

Begermy

El-Begermy

Kassamy

2020

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

View full text Add to dashboard Cite

Background : Nasal septal surgery is the most frequent cause of nasal septal perforations (NSP). Sometimes when symptomatic they need repair. There are many methods described for repair with a variable percent of success. The multiplicity of techniques and approaches reflect the difficulty of repair. Objective: To describe a new effective method to repair NSP using a butterfly composite conchal cartilage graft (BCG) with local posteriorly pedicled flap in repair of NSP. Patients and Methods: Eleven patients with NSP after nasal septum surgery were involved in this study. In all of them an ample flap, right sided, pedicled posteriorly on sphenopalatine artery was fashioned. It was rotated to cover the perforation on the right side. A composite skin choncal cartilage graft equal to NSP diameter is dissected. The cartilage graft was fashioned by splitting its edge circumferentially with a depth of 2-3 mm and was positioned with the skin island lying on the left side and the fissured graft edge embracing the perforation cartilaginous border inside its fissure. The graft and the flap were fixed in place with quilting and mattress sutures and silastic sheets on both sides. Mucosal flap was used alone in three cases with small perforations. Results: Complete closure of NSP was achieved in 10 cases (91%). Only one case the graft was rejected with partial closure of the perforation due to bad fixation and secondary infection. Conclusion: BCG was an excellent graft to repair NSP if associated with posteriorly pedicled mucosal flap supplied by the sphenopalatine artery.

show abstract

Surgical repair of nasal septal perforations: A systematic review and meta‐analysis

Fermin

Bui

McCoul

et al. 2022

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Background: A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes. Methods: PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes. Results:The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p < 0.01), with moderate heterogeneity between studies (I 2 = 42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes. Conclusion:Nasal septal perforation surgical repair success rates are comparable regardless of technique.

show abstract

Upper lateral cartilage composite flap for closure of complicated septal perforations

Abstract: 4. Laryngoscope, 127:1767-1771, 2017.

Cited by 6 publications

References 37 publications

Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix

Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix

Use of Butterfly Composite Conchal Cartilage Graft with Local Posteriorly Pedicled Flap in Repair of Nasal Septum Perforations

Surgical repair of nasal septal perforations: A systematic review and meta‐analysis

Contact Info

Product

Resources

About