Septal Perforation Repair How I Do It

The nasal septum separates the two nasal cavities. It is composed of cartilage and bone, and is lined by soft tissue called “mucosa” on each side. Normally the nasal septum is continuous from the tip of the nose back to the nasopharynx (part of the throat connecting with the nasal cavities). If there is a hole in the nasal septum, it is called a nasal septal perforation. A septal perforation results in abnormal, or turbulent, airflow through the hole in the septum, and this can cause drying of the tissue around the perforation, and this can lead to nasal crusting and/or bleeding. Depending on the size of the hole, patients may also experience whistling through the nose during breathing, or feel like they can’t breathe as well through the nose. On the other hand, some patients have no symptoms at all from septal perforations. Septal perforations can occur after septal surgery, traumatic septal fractures, nasal cannulas, illicit intranasal drug use, cancer, or underlying inflammatory conditions like autoimmune diseases. Once they occur, if they cause symptoms, then treatment is indicated. Patients can try topical moisturization with saline or other topical ointments, but if symptoms remain, they can be offered different procedures, one being surgical repair. Historically, surgical repair of septal perforations has been considered challenging. Many operative techniques have been published with variable success rates having been reported (anywhere from 70-90+%). No clearly superior technique has been demonstrated in the literature, but a recently described technique called the “anterior ethmoid artery flap” shows significant promise. The flap is theoretically based on the vessels perforating the cribiform plate from the anterior ethmoid artery, and these vessels supply the nasal septum and nasal floor mucosa. This tissue can be harvested endoscopically then advanced/rotated over the septal perforation for complete closure of the perforation.

The major benefits of this technique are:
1. The endoscopic approach avoids any external nasal scar, such as would occur with a rhinoplasty.
2. There is minimal to no tension at the suture line after closure of the perforation.
3. It is a unilateral flap so the other side of nasal septum and floor is still available for a revision surgery if for some reason the first attempt failed.

John Craig and other ENT surgeons at Henry Ford Health System in Detroit, MI offer this surgical technique to repair septal perforations. Ask your physician or ENT surgeon about this new and exciting surgical technique (anterior ethmoid artery flap).

Author

Ariyani

Como educador, estou profundamente engajado no desenvolvimento dos estudantes em ambiente escolar, adotando métodos pedagógicos que valorizam conexões genuínas e são movidos por inovação e fervor. É minha vocação guiar os alunos na jornada de se tornarem uma geração notável, empregando estratégias de ensino amplamente aclamadas por prestigiadas instituições acadêmicas ao redor do globo - events.zulekhahospitals.com