Resident Mayo Clinic Arizona Mayo Clinic Arizona Phoenix, Arizona
Background: Nasal septal perforation repair is commonly attempted with procedures utilizing bilateral nasal mucosal flaps with an interposition graft. Though varied graft materials have been used, comparative studies are lacking. The aim of this study was to review an extensive perforation repair experience with bilateral mucosal flap closures in which temporalis fascia, septal cartilage, septal bone, and auricular perichondrium have been used as interposition graft material. Failure rates were determined and compared between graft types.
Methodology/Principal: A retrospective review of one surgeon's experience attempting 372 mucosal flap perforation closures over an 18-year period was performed. Selection of the autogenous graft used in each repair was influenced by clinical circumstances. Complete perforation closure was the primary outcome and was determined at the last postoperative visit.
Results: The most frequently used graft material was temporalis fascia (56.2%, mean perforation length 16.8 mm), followed by septal cartilage (22.0%, mean length 8.6 mm), auricular perichondrium (13.2%, mean length 11.8 mm), and septal bone (4.0%, mean length 10.7 mm). The closure failure rate was 6.6%. Statistical analysis determined graft type did not affect closure outcomes (p=0.5) when comparing the use of fascia, cartilage, or perichondrium for perforations. Multivariate modeling including perforation length, height and graft material was not a significant predictor of closure (p=1).
Conclusions: High septal perforation closure success rates can be achieved with repairs that utilize bilateral mucosal flaps and varied, autogenous interposition graft materials. Our findings suggest graft material plays a secondary role to complete mucosal flap closure to achieve perforation repair success when used by an experienced perforation surgeon.