1.INTRODUCTION
Nasal septal perforation (NSP) may be defined as a defect occurring in
the cartilage and/or bone of the nasal septum, causing the passage of
air between the two nasal cavities. The prevalence of NSP ranges between
0.9% and 2.5%1. Although iatrogenic factors are the
most frequent cause of NSP, it can also be encountered with intranasal
drug dependence and inflammatory or infective pathologies. The most
common iatrogenic causes of NSP include nasal septal surgeries, mucosal
cauterizations, and long-term nasal tampon application.
While NSP is asymptomatic in the majority of cases, it can also manifest
with varying clinical symptoms depending on the location and size of the
perforation. The most common such symptoms include epistaxis,
respiratory difficulty, a whistling sound, and nasal incrustation.
Surgical treatment of NSP remains a troubling and difficult procedure
for rhinological surgeons. No effective and simple technique has to date
been described for all perforations. Several methods, such as unilateral
sliding flaps, bilateral sliding flaps, interposition grafts, and nasal
button application have therefore been investigated in the literature.
These methods all have their own advantages and disadvantages. Surgical
success rates using these methods are in the region of 90%, the
location and size of the septal perforation being the most important
factor affecting the selection of the surgical technique and its
success. Small and posterior perforations can be closed more easily than
larger and anterior ones. In bilateral repositioned flaps, difficulties
may be experienced in suturing the inferior-based flaps while pulling
upward. In interposition grafts, nasal obstruction can be arisen because
of the mass effect and the establishment of a secondary surgery field is
another disadvantage. Also, in flaps in which upper lateral cartilage
mucosa are used, dorsal anomalies can be occurred that may require
revision surgery2. Posterior pedicle flaps created by
an incision superior to the perforation have previously been
described3.
This study presents a bipediculated crescent-shaped unilateral sliding
flap technique, designed and used by us as a novel modification for NSP
repair, and its surgical outcomes. The advantage of our surgical
technique is that a second, anterior-based pedicle is created by
extending the incision in a crescent shape in an anterior direction,
thus enhancing flap mobilization and stabilization. To the best of our
knowledge, this technique has not been previously described in the
literature.