Septal perforation

Aim: This study isolates septal perforations due to nasal surgery for clinical analysis and their effect on bilateral mucosal flap repair. Methods: This is a retrospective review of a single surgeon’s 20-year experience with endonasal perforation repair utilizing bilateral mucosal advancement flaps supported with an autologous tissue interposition graft. Patients with a minimum of 4-month postoperative follow-up were included in the study. Comparative analyses of repair failure rates and perforation size of failures between surgical and non-surgical etiologies were performed. Results: Three hundred ninety-two patients met the criteria for inclusion in the study. The incidence of perforation and prior septal surgery was 40.6%. Overall repair closure in patients with a minimum of 4 months follow-up was 94.8%. Failures were noted in 5.7% of surgical and 4.7% of non-surgical perforation etiologies (P = 0.816). Mean differences in perforation length and height in failed repairs between non-surgical and surgical etiologies (19.4 vs. 13.7 and 15.5 vs. 9.3 mm, respectively) were significant (P = 0.048 length, P = 0.006 height). Conclusion: Post-surgical nasal septal perforations can be repaired with a low rate of failure. However, this study found that the size of perforations in failed repairs was significantly smaller in patients with a history of septal surgery, suggesting that prior septal surgery increases the technical difficulty of a bilateral flap perforation repair.