Rokkjær Malene Sine, Barrett Thomas Qvist, Petersen Claus Gregers
ENT Surgery, Aarhus University Hospital, Denmark.
Dan Med Bull. 2010 Oct;57(10):A4196.
Surgical closure of nasal septal perforations is a challenging procedure. Several approaches and techniques have been described with different levels of success. We report our experience in nasal septal perforation surgery.
We reviewed a sample of 19 patients who underwent surgical closure of nasal septal perforations. The perforations varied in size from 3 mm to 25 mm (mean 13 mm). Outcome was assessed on the basis of a comparison of the preoperative and final follow-up assessment of perforation size and symptoms. The surgical technique is based on an endonasal approach with dissection of bilateral bipedicled mucoperichondrial/-periosteal advancement flaps and interposition of a septal or conchal cartilage graft.
Symptomatic resolution was documented for 18 of the 19 patients (95%). Complete closure was accomplished in 16 patients (84%) without major complications. We observed no graft donor site morbidity.
The technique described uses recognized surgical principles to reconstruct the original nasal architecture and physiology. The results achieved sustain that the method offers both durability and strength. The endonasal approach leaves no scars, reduces risk of tip-rotation and offers sufficient view and space for instrumentation. We conclude that this method is suitable for treatment of perforations up to a vertical height of at least 25 mm.
鼻中隔穿孔的手术闭合是一项具有挑战性的操作。已经描述了几种方法和技术，成功率各不相同。我们报告我们在鼻中隔穿孔手术方面的经验。
我们回顾了19例接受鼻中隔穿孔手术闭合的患者样本。穿孔大小从3毫米到25毫米不等（平均13毫米）。根据术前和最终随访时穿孔大小及症状的比较来评估结果。手术技术基于鼻内入路，分离双侧带蒂黏膜软骨膜/骨膜推进瓣，并置入鼻中隔或耳甲软骨移植物。
19例患者中有18例（95%）症状得到缓解。16例患者（84%）实现了完全闭合，且无重大并发症。我们未观察到移植物供区出现并发症。
所描述的技术运用公认的手术原则来重建原始的鼻腔结构和生理功能。所取得的结果表明该方法兼具持久性和强度。鼻内入路不留疤痕，降低了鼻尖旋转的风险，并为器械操作提供了足够的视野和空间。我们得出结论，该方法适用于治疗垂直高度至少达25毫米的穿孔。
