[Repair techniques in perforations of the nasal septum].

According to my experience extending over more than 20 years (more than 100 cases) in the treatment of septal perforations, I have the deep conviction that all techniques using local flaps should actually be considered to be obsolete, as the blood supply is insufficient. Perforations with diameter up to 4 cm can be closed in a one stage procedure with extensive dissection of the muco-perichondrium and mucoperiosteum of the septum, the vault and the vestibular and cavity floor. The hole in the quadrangular plate can be reduced by a push back or push down manoeuver of part of the cartilage. For closure of perforations larger than 4 cm in diameter, I use a 2-3 stage procedure using a composite buccal flap with three layers (mucosa-cartilage and mucosa) and a gingivo-labial pedicle. Thus all kinds and sizes of perforations can be closed surgically avoiding the use of silicone obturators which only enlarge the hole.