Abdel-Aty Yassmeen, Cain Rachel B, Taylor Cullen, Marino Michael J, Lal Devyani, Bansberg Stephen F
Department of Otolaryngology Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Southwestern Colorado Ear, Nose, and Throat Associates, Durango, Colorado, USA.
Otolaryngol Head Neck Surg. 2021 Aug;165(2):370-374. doi: 10.1177/0194599820982912. Epub 2021 Jan 26.
This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported.
Case series.
Tertiary care center.
In this institutional review board-approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up.
Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs.
Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.
本研究回顾了一组同时进行鼻中隔穿孔修复和鼻内镜鼻窦手术的患者。我们介绍一种使用双侧黏膜瓣及自体植入移植物的鼻内穿孔修复技术。讨论了联合手术患者的术中及术后管理，并报告了穿孔闭合的结果。
病例系列。
三级医疗中心。
在这项经机构审查委员会批准的回顾性病历审查中，确定了1992年3月至2020年3月期间同时接受双侧黏膜瓣鼻中隔穿孔修复和鼻内镜鼻窦手术的成年患者。提取并分析了随访至少3个月的患者的人口统计学、临床表现、穿孔大小、手术技术和结果等数据。
56例患者符合研究纳入标准。鼻塞/鼻充血是最常报告的症状（80.4%），其次是结痂和鼻出血。手术时测得的平均穿孔大小为长14.7（范围3 - 41）mm，高9.3（范围2 - 23）mm。颞肌筋膜是最常使用的植入移植物材料（57.9%）。在最后一次随访时，51例（91.1%）患者的穿孔完全闭合。在最后48次修复尝试中仅出现1次失败。
鼻中隔穿孔患者可能并存慢性鼻窦炎。同时进行鼻窦手术和穿孔修复的可行性受到质疑。我们的回顾表明，在同一环境下先进行鼻窦手术，然后进行双侧黏膜瓣手术时，穿孔闭合率很高。
