Alobid Isam
Unidad de Rinología y Base de Cráneo, Departamento de ORL, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España.
Acta Otorrinolaringol Esp (Engl Ed). 2018 May-Jun;69(3):165-174. doi: 10.1016/j.otorri.2017.02.001. Epub 2017 May 27.
The management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation.
Inspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations.
The remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon.
鼻中隔穿孔的处理对外科医生来说是一项挑战。已经描述了各种各样的手术技术，采用了不同的方法。没有科学证据支持某一种特定方法。本综述的目的是针对每种鼻中隔穿孔病例，提供一份关于所选技术的实用指南。
检查鼻黏膜、穿孔大小、位置，尤其是骨软骨支撑情况，是成功手术的关键。对于鼻中隔黏膜的滑动或旋转皮瓣，必须提前了解鼻中隔黏骨膜或黏骨膜骨膜是否能够掀起，否则不适合使用这些皮瓣。外侧壁或鼻底皮瓣是替代选择。对于完全或近乎完全穿孔，可考虑使用颅骨膜瓣。
鼻中隔残余部分及骨软骨支撑状况是鼻中隔穿孔处理的决定因素。每个病例都应单独评估，并根据穿孔大小和位置、黏膜质量、个人病史、既往手术情况以及外科医生的经验来选择治疗方法。
