Endoscopic Sandwich Technique for Moderate Nasal Septal Perforations

What would be a good surgical technique for the treatment of nasal septal perforations with diameters of 1 to 2 cm?

Background: Surgical therapy is required for nasal septal perforation, which is a complete defect of cartilage or bone and mucosa in the bilateral nasal septum. Although many approaches and techniques have been reported, the success rate fluctuates between 75 percent and 96 percent, with a reperforation rate of 12 to 48 percent. It is especially a challenge when the perforation is greater than 1 cm, because there is no standard choice of approach and technique.

Study design: Retrospective clinical research.

Setting: Department of Otolaryngology, First Affiliated Hospital, and Otolaryngology Institute at Sun Yat-sen University, Guangzhou, Guangdong, China.

Synopsis: The authors described their sandwich technique for 1 to 2-cm perforations. They said the advantages include better surgical vision under endoscope, easier manipulation and a high success rate. Following vasoconstriction, incision, elevation and graft preparation, the sandwich implantation included cartilage or bone plate coated by two pieces of quadriceps fascia bilaterally and interposed between two nasal septum mucosal flaps and a fourth layer of middle turbinate mucosa placed over the perforation as an overlay graft if necessary, followed by biological glue (fibrin sealant) and then layering of Gelfoam gauze to secure and support the grafts in position, supplemented with expandable sponge packing. At the end of the three-month follow-up, 12 patients (92.3 percent) were completely healed and one case received incomplete closures without any postoperative symptoms. There were no complications.

Bottom line: The transnasal endoscopic sandwich technique for repairing moderate nasal septal perforation (1-2 cm) has a high success rate and is easy to perform.

Reference: Chen FH, Rui X, Deng J, Wen YH, Xu G, Shi JB. Endoscopic sandwich technique for moderate nasal septal perforations. Laryngoscope. 2012;122(11):2367-2372.