Otolaryngologists develop technique for septal perforation repair

A team of UT Southwestern researchers in the Department of Otolaryngology – Head and Neck Surgery has developed a new, tension-free technique to repair perforated septa. The procedure, which utilizes an interposition graft as opposed to the traditional vascularized flaps made of mucosal tissue, is outlined in a study in the journal The Laryngoscope.

“It was a brilliant idea by former resident Dr. Eric Flavill to use a graft that is biodegradable and coated with the patient’s own deep temporal and temporoparietal connective tissue to conquer a perplexing problem in nasal plastic surgery,” said the study’s co-author Dr. Jim Gilmore, Associate Professor of Otolaryngology. “The old repair techniques have disappointing long-term results. These grafts are tissue-compatible with little foreign-body reaction, and provide long-lasting structural support.”

In the study, eight patients received a complete septal perforation repair using the interposition grafts instead of the older, mucosal flap repair technique. The new, tension-free technique does not rely on intraoperative mucosal closure of the septal perforation, but instead uses an open rhinoplasty approach and avoids additional incisions and tension in the tissue surrounding the perforation. The inserted graft then acts as a scaffold for mucosal healing.

The results of the study included a 100 percent perforation-closure rate for the eight patients who received the multilayered interposition graft. Each patient had complicating factors such as large perforations or prior failed surgeries that made the repairs less amenable to the older technique.

Nasal septal perforations – tears or holes that develop in cartilage between the nostrils – can occur as the result of trauma, septal surgery, sinus surgery, cocaine use, and even chronic use of over-the-counter nasal decongestants. The perforations can obstruct patients’ normal nasal flow and cause symptoms that include nasal crusting, nose bleeds, nasal discomfort, persistent foul smell, and sense of nasal blockage.