Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-20T12:22:27.063Z Has data issue: false hasContentIssue false
  • English
  • Français

Bone and temporal fascia graft for the closure of septal perforation

Published online by Cambridge University Press:  29 June 2007

David Núñ;ez-Fernández ,
Jan Vokurka  and
Viktor Chrobok
David Núñ;ez-Fernández*
Affiliation:
Department of Otorhinolaryngology, Head nad Neck Surgery, University Hospital of Hradec Králové, Charles University Faculty of Medicine in Hradec Králové, Echegararay Medical Center, Mexico city, Mexico. Department of Czech Republic and Otolaryngology Unit, Echegaray Medical Center, Mexico City, Mexico.
Jan Vokurka
Affiliation:
Department of Otorhinolaryngology, Head nad Neck Surgery, University Hospital of Hradec Králové, Charles University Faculty of Medicine in Hradec Králové, Echegararay Medical Center, Mexico city, Mexico.
Viktor Chrobok
Affiliation:
Department of Otorhinolaryngology, Head nad Neck Surgery, University Hospital of Hradec Králové, Charles University Faculty of Medicine in Hradec Králové, Echegararay Medical Center, Mexico city, Mexico.
*
Address for correspondence: David Núñez-Fernández, M.D., Unidad de Otorrinolaringologfa, Blvd. M.A. Camacho 959-103, Bosques de Echegaray, 53310, Naucalpan, Edo. de México, Mexico. e-mail: rhinogroup@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To assess the reliability of temporal fascia and bone graft for the closure of septal perforation.

Study design

Prospective longitudinal non-randomized.

Methods

The 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.

Results

All 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.

Conclusions

We 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.

Keywords

Nasal septumFistulaSurgery, operative
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 112 , Issue 12 , December 1998 , pp. 1167 - 1171
Copyright
Copyright © JLO (1984) Limited 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnstein, D. P., Berke, G. S. (1989) Surgical considerations in the open rhinoplasty approach to closure of septal perforations. Archives of Otolaryngology-Head and Neck Surgery 115: 435–438.Google Scholar
Beekhuis, G. J., Eisenstein, B. (1977) Repair of nasal septal perforation with a silicone button. Laryngoscope 87: 635–637.Google Scholar
Bewarder, F., Pirsig, W. (1978) Long-term results of submucous septal resection (author's transl.). Laryngology Rhinology and Otology (Stuttg) 57: 922–930.Google Scholar
Facer, G. W., Kern, E. B. (1979a) Nonsurgical closure of nasal septal perforations. Archives of Otolaryngology 105(1): 6–8.Google Scholar
Facer, G. W., Kern, E. B. (1979b) Nasal septal perforations: use of silastic button in 108 patients. Rhinology 17(2): 115–120.Google Scholar
Fairbanks, D. N. F. (1980) Closure of septal perforations. Archives of Otolaryngology – Head and Neck Surgery 106: 509–513.Google Scholar
Fairbanks, D. N. F., Chen, S. C. A. (1970) Closure of large nasal septum perforations. Archives of Otolaryngology 91: 403–406.Google Scholar
Fairbanks, D. N. F., Fairbanks, G. R. (1993) Nasal septal perforations: management and prevention, In Aesthetic Plastic Surgery: Rhinoplasty. (Daniels, R. K., ed.) Little Brown Company, Boston-Toronto-London, pp 631–642.Google Scholar
Frankze, R. O. (1970) Temporalis fascia (letter). Archives of Otolaryngology 91: 493.Google Scholar
Gollom, J. (1968) Perforation of the nasal septum – the reversal flap technique. Archives of Otolaryngology 88: 518.Google Scholar
Hussain, A., Murthy, P. (1997) Modified tragal cartilage-temporoparietal and deep temporal fascia sandwich graft technique for repair of nasal septal perforations. Journal of Laryngology and Otology 111: 435–437.Google Scholar
Karlan, M. S., Ossof, R. H., Sisson, G. A. (1982a) A compendium of intranasal flaps. Laryngoscope 92: 774–782.Google Scholar
Karlan, M. S., Ossoff, R., Christu, P. (1982b) Reconstruction for large septal perforations. Archives of Otolaryngology 108: 433–436.Google Scholar
Kridel, R. W. H., Appling, D., Wright, W. K. (1986) Septal perforation closure utilizing the external septorhinoplasty approach. Archives of Otolaryngology – Head and Neck Surgery 112: 168–172.Google Scholar
Kridel, R. W. H., Foda, H., Lunde, K. C. (1998) Septal perforation repair with acellular dermal allograft. Archives of Otolaryngology – Head and Neck Surgery 124: 73–78.Google Scholar
Lewis, F. O. (1915) Transplantation of cartilage in the correction of septal deformities. Annals of Otology, Rhinology and Laryngology, Sept. 1915, cited in Laryngoscope (1916) 26: 318.Google Scholar
Low, W. K., Willatt, D. J. (1992) Submucous resection for deviated nasal septum: a critical appraisal. Singapore Medical Journal 33: 617–619.Google Scholar
Romo, T., Jablonski, R. D., Shapiro, A. L., McCormish, S. A. (1995) Long-term nasal mucosal tissue expansion use in repair of large nasoseptal perforations. Archives of Otolaryngology – Head and Neck Surgery 121: 327–331.Google Scholar
Slavit, D. H., Bansberg, S. F., Facer, G. W., Kern, E. B. (1995) Reconstruction of caudal end of the septum. Archives of Otolaryngology – Head and Neck Surgery 121: 1091–1098.Google Scholar
Tardy, M. E. Jr. (1977) Practical suggestions on facial plastic surgery – how I do it. Sublabial mucosal flap: repair of septal perforations. Laryngoscope 87(2); 275–278.Google Scholar
Vuyk, H. D., Vershuis, R. J. (1988) The inferior turbinate flap for closure of septal perforations. Clinical Otolaryngology 13(1): 53–57.Google Scholar
Wright, W. K. (1970) Closure of large nasal septum perforations (letter). Archives of Otolaryngology 91: 492–493.Google Scholar