Heller Justin B, Gabbay Joubin S, Trussler Andrew, Heller Misha M, Bradley James P
Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA 90095, USA.
Ann Plast Surg. 2005 Nov;55(5):456-9. doi: 10.1097/01.sap.0000184012.63970.c3.
Nasal septum perforations from surgical submucous resection, septoplasty, blunt trauma, and substance abuse may cause epistaxis, nasal obstruction, discharge, crusting, dryness, pain, and whistling. While small symptomatic perforations are closed with local mucosal flaps, options for closure of large symptomatic perforations are limited. A local pedicled flap, the facial artery musculomucosal (FAMM) flap was studied in patients with large symptomatic nasal septal defects.
Patients included in the study had (1) a nasal septal defect measuring at least 20 mm in greatest dimension; and (2) related symptoms of nasal crusting, discharge, dryness, obstruction, epistaxis, pain, or whistling. Six patients (3 males; 3 females) met these criteria and received FAMM flap repair. Outcomes were assessed based on comparison of preoperative versus last follow-up (range, 10-30 months; mean 17 months) assessment of perforation size and symptomatology. Overall discomfort was rated at each time point on a 1-10 scale.
Age at time of operation ranged from 21 to 44 years, with a mean of 34 years of age. Causes of septal perforation included blunt trauma (50%), cocaine abuse (33%), and submucous resection (17%). Preoperatively, maximal recorded dimensions of septal perforations ranged from 3.1 to 4.0 cm with a mean of 3.5 +/- 0.4 cm. Symptoms included pain (83%), dryness (67%), crusting (50%), discharge (33%), epistaxis (33%), and obstruction (33%). Three or more symptoms were experienced by 5 patients (83%). Overall discomfort ranged from 6-10, with a mean of 8.4. Postoperatively at last follow-up, all 6 patients (100%) achieved closure of their septal defect (P < 0.001). Overall discomfort score was zero for all 6 patients (100%) (P < 0.0001). Complete symptomatic resolution was also noted among all 6 patients (100%) (P < 0.01).
In summary, the advantages of the FAMM flap closure technique were (1) no visible external scar, with minimal donor site morbidity; (2) successful closure of large septal defects (>2 cm) with vascularized tissue in a single stage; and (3) resolution of patient symptomatology.
手术黏膜下切除术、鼻中隔成形术、钝性外伤及药物滥用导致的鼻中隔穿孔可引起鼻出血、鼻塞、流涕、结痂、干燥、疼痛及鼻鸣。虽然有症状的小穿孔可采用局部黏膜瓣封闭，但封闭有症状的大穿孔的选择有限。本研究对有症状的大鼻中隔缺损患者采用局部带蒂皮瓣即面动脉肌黏膜（FAMM）瓣进行治疗。
纳入研究的患者需满足以下条件：（1）鼻中隔缺损最大径至少20 mm；（2）伴有鼻结痂、流涕、干燥、鼻塞、鼻出血、疼痛或鼻鸣等相关症状。6例患者（3例男性，3例女性）符合这些标准并接受了FAMM瓣修复。通过比较术前与末次随访（范围10 - 30个月，平均17个月）时穿孔大小及症状学表现来评估治疗效果。每次随访时采用1 - 10分制对总体不适程度进行评分。
手术时年龄范围为21至44岁，平均34岁。鼻中隔穿孔的原因包括钝性外伤（50%）、可卡因滥用（33%）及黏膜下切除术（17%）。术前，鼻中隔穿孔最大记录尺寸范围为3.1至4.0 cm，平均为3.5±0.4 cm。症状包括疼痛（83%）、干燥（67%）、结痂（50%）、流涕（33%）、鼻出血（33%）及鼻塞（33%）。5例患者（83%）有三种或更多症状。总体不适程度评分为6 - 10分，平均8.4分。末次随访时，所有6例患者（100%）鼻中隔缺损均成功封闭（P < 0.001）。所有6例患者（100%）的总体不适评分均为零（P < 0.0001）。所有6例患者（100%）症状均完全缓解（P < 0.01）。
总之，FAMM瓣封闭技术的优点包括：（1）无可见外部瘢痕，供区并发症极少；（2）能一期成功用带血管组织封闭大的鼻中隔缺损（>2 cm）；（3）患者症状得以缓解。
