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.