What does secondary septal surgery reveal about the potential contribution of the nasal swell body (NSB) to persistent nasal obstruction following initial successful septal perforation repair?
BOTTOM LINE: Septal perforation repair using a superior bipedicle flap carries the potential for the NSB to contribute to persistent postoperative nasal obstruction, but the NSB can be surgically reduced, without re-perforation, to relieve obstructive symptoms.
BACKGROUND: Although surgical success rates for symptomatic perforation of the nasal septum have increased with advanced methods like the bilateral mucosal flap technique, postsurgical patients may experience persistent obstructive symptoms. Involvement of the NSB is a potential cause of these postsurgical symptoms, and surgical reduction of the NSB might help to alleviate them.
STUDY DESIGN: Retrospective chart review.
SETTING: Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Phoenix.
SYNOPSIS: Researchers conducted a retrospective chart review of 232 patients who received perforation repairs using bilateral mucosal flaps performed by the senior author between October 2008 and April 2019. Data regarding patient demographics, perforation characteristics, primary closure technique, and secondary surgical procedures for persistent postoperative obstruction were analyzed. Thirty patients (13 males, 17 females, mean age 49.4 years) who underwent a secondary septal procedure for persistent nasal obstruction were identified. Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed pre- and post-revision surgery. An inferiorly advanced NSB was determined to be a contributing factor for obstruction on the left side in 23 cases. Reduction of the NSB alone was performed in 12 patients. Eleven patients underwent formal septoplasty, and NSB soft tissue reduction was performed in four of these patients. After follow-up evaluation (mean 5.9 months) on 29 of the original 30 patients, 28 reported subjective improvement in nasal obstruction. Authors conclude that the NSB can be thinned to improve obstruction as an isolated procedure or in combination with other procedures, without septal re-perforation.
CITATION: Ghorab S, Taylor CM, Bansberg SF. The nasal swell body and septal perforation repair. Laryngoscope. 2020;130:2795-2801.