Benha M. J.
Vol. 26 No 3 Sept. 2009
Repair of Nasoseptal Perforation by an External Approach Using Different Graft Materials
Adel Helmy MD, Ahmed S. El-Kady MD and Ahmed Hussein MD.
Department of Otorhinolaryngology, Faculty of Medicine, Benha University.
Objectives: The current study aimed to compare among different graft materials (tragus perichondrium, human acellular dermal graft and inferior turbinate flap) used for the repair of the nasoseptal perforation by an external approach.
Patients and Methods: The study included 30 patients with traumatic nasal septal perforation located in the anterior cartilaginous part of the nasal septum. All patients underwent full history taking, complete clinical otorhinolaryngological examination including nasal examination by anterior rhinoscopy and rigid 0° endoscope to detect the actual size, extent of the septal perforation and to exclude the associated pathological lesions. The patients were divided into 3 groups: I, II and III according to the graft material used in the repair of the nasal septal perforation. Group I: included l0 patients in whom the repairs of the nasal septal perforation were performed by the use of tragus perichondrium graft, group II: Included 10 patients in whom the repairs of the nasal septal perforation were performed by the use of human acellular dermal graft (Alloderm) and group III: included 10 patients in whom the repairs of the nasal septal perforation were performed by the use of the inferior turbinate flap. One surgical approach, the external transcolumellar approach, was performed in all patients for repair of the nasoseptal perforation. Patients were examined twice weekly in the first month then twice monthly for the next 5 months, for the success of closure of the septal perforation and for the occurrence of any complication.
Results: The study included 30 patients, 19 males and 11 females with age ranged from 19 to 35 years. The size of the perforation ranged from 0.5 × 0.5 cm to 2×2 cm in each group. Small perforations (<1.5×1.5cm) were reported in 21 patients (70%), while the large perforations (≥ 1.5 ×1.5cm) were reported in 9 patients (30%). The Success rate in group I was 70%, 7 out of 10 patients, while in group II was 90%, 9 out of 10 patients and in group III was 80%, 8 out of 10 patients. Failure reported in 6 out of 30 patients, one patient out of the 6 failed had a perforation less than 1.5×1.5 cm and the remaining 5 patients had a large perforation. Stenosis of nasal vestibule was reported in 2 patients of group I, one patient in group II while not recorded in group III. Bleeding, unilateral nasal obstruction and synachia were reported in 2, 3 and 2 patients, respectively of group III. Marked crustations were also reported in few patients of group III.
Conclusion: The external transcolumellar approach has many advantages, as it is easy, allows direct access and good exposure of the perforation and surroundings and permits a precise placement and stabilization of the grafts. The highest perforation closure rates were with human acellular dermal graft with the advantage of absence of donor site morbidity. The inferior turbinate flap and tragus cartilage graft also had a good closure rates but not superior to the human acellular dermal graft.