Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Septal perforation repair using costal chondro-perichondrial graft: a case report

  • Received : 2023.11.22
  • Accepted : 2024.10.02
  • Published : 2024.10.20
Download PDF
⟨ Previous Next ⟩

Abstract

Septal perforation is an anatomical defect of the nasal septum that leads to impaired nasal function, including obstruction and respiratory issues. In this study, a novel surgical approach was introduced to address septal perforations, focusing on the use of costal composite chondro-perichondrial grafts bilaterally in a symmetric manner. This composite graft, composed of costal cartilage and perichondrium, provides mechanical support, aids vascularization, and minimizes perichondrial shrinkage. A case study of a 23-year-old patient with septal perforation resulting from multiple rhinoplasty procedures is presented. The surgical procedure involved the use of a composite graft to close the septal perforation and correct the nasal deformity. The postoperative results demonstrated successful septal perforation closure and relief from nasal discomfort. This study highlights the advantages of this method, particularly its simplicity and straightforward surgical procedures for closing septal perforations of various sizes, and its suitability for rhinoplasty surgeons who are familiar with costal cartilage harvesting.

Keywords

References

  1. Diamantopoulos II, Jones NS. The investigation of nasal septal perforations and ulcers. J Laryngol Otol 2001;115:541-4.
  2. Garaycochea O, Santamaria-Gadea A, Alobid I. State-of-theart: septal perforation repair. Curr Opin Otolaryngol Head Neck Surg 2023;31:11-6.
  3. Wong S, Raghavan U. Outcome of surgical closure of nasal septal perforation. J Laryngol Otol 2010;124:868-74. https://doi.org/10.1017/S0022215110000745
  4. Alobid I. Endoscopic closure of septal perforations. Acta Otorrinolaringol Esp (Engl Ed) 2018;69:165-74. https://doi.org/10.1016/j.otorri.2017.02.001
  5. Lu GN, Tawfik O, Sykes K, Kriet JD, Durham D, Humphrey CD. Association of skin and cartilage variables with composite graft healing in a rabbit model. JAMA Facial Plast Surg 2019;21:44-9. https://doi.org/10.1001/jamafacial.2018.1044
  6. Yoon SH, Kim CS, Oh JW, Lee KC. Optimal harvest and efficient use of septal cartilage in rhinoplasty. Arch Craniofac Surg 2021;22:11-6. https://doi.org/10.7181/acfs.2020.00486
  7. Lanier B, Kai G, Marple B, Wall GM. Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol 2007;99:473-9. https://doi.org/10.1016/S1081-1206(10)60373-0
  8. Santamaria-Gadea A, Lopez-Chacon M, Langdon C, Van Gerven L, Valls-Mateus M, Bernal-Sprekelsen M, et al. Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits. Rhinology 2018;56:386-92.
  9. Friedman M, Ibrahim H, Ramakrishnan V. Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 2003;113:1425-8. https://doi.org/10.1097/00005537-200308000-00031
  10. Castelnuovo P, Ferreli F, Khodaei I, Palma P. Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 2011;13:411-4. https://doi.org/10.1001/archfaci.2011.44
  11. Santamaria-Gadea A, Vaca M, de Los Santos G, Alobid I, Marino-Sanchez F. Greater palatine artery pedicled flap for nasal septal perforation repair: radiological study and case series. Eur Arch Otorhinolaryngol 2021;278:2115-21. https://doi.org/10.1007/s00405-020-06230-1
  12. Romo T 3rd, Jablonski RD, Shapiro AL, McCormick SA. Longterm nasal mucosal tissue expansion use in repair of large nasoseptal perforations. Arch Otolaryngol Head Neck Surg 1995;121:327-31. https://doi.org/10.1001/archotol.1995.01890030057009
  13. Goh AY, Hussain SS. Different surgical treatments for nasal septal perforation and their outcomes. J Laryngol Otol 2007;121:419-26. https://doi.org/10.1017/S002221510700566X
  14. Kim SW, Rhee CS. Nasal septal perforation repair: predictive factors and systematic review of the literature. Curr Opin Otolaryngol Head Neck Surg 2012;20:58-65. https://doi.org/10.1097/MOO.0b013e32834dfb21
  15. Toriumi DM, Cappelle QM, Chung V. Use of costal perichondrium as an interpositional graft for septal perforation closure. JAMA Facial Plast Surg 2017;19:121-7. https://doi.org/10.1001/jamafacial.2016.1367
  16. Rokkjaer MS, Barrett TQ, Petersen CG. Good results after endonasal cartilage closure of nasal septal perforations. Dan Med Bull 2010;57:A4196.
  17. Woolford TJ, Jones NS. Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft. J Laryngol Otol 2001;115:22-5. https://doi.org/10.1258/0022215011906939
  18. Giacomini PG, Ferraro S, Di Girolamo S, Ottaviani F. Large nasal septal perforation repair by closed endoscopically assisted approach. Ann Plast Surg 2011;66:633-6. https://doi.org/10.1097/SAP.0b013e3181dec776
  19. Hussain A, Murthy P. Modified tragal cartilage: temporoparietal and deep temporal fascia sandwich graft technique for repair of nasal septal perforations. J Laryngol Otol 1997;111:435-7. https://doi.org/10.1017/S0022215100137569
  20. Hanci D, Ustun O, Yilmazer AB, Goker AE, Kumral TL, Uyar Y. Costal cartilage and costal perichondrium sandwich graft in septal perforation repair. J Craniofac Surg 2020;31:1327-9. https://doi.org/10.1097/SCS.0000000000006320