Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Ann Otol Rhinol Laryngol. 2024 Jan;133(1):14-21. doi: 10.1177/00034894231178964. Epub 2023 Jun 26.
Nasal septal perforation (NSP) repair is challenging surgery considered in patients with symptomatic NSP intractable to conservative treatments. This study aimed to assess the success rate and identify factors affecting the surgical outcome of NSP by analyzing consecutive series of NSP repairs by a single surgeon.
We enrolled 84 patients diagnosed with NSP and who underwent surgical repair of NSP by a single surgeon (Y.J.J.) between November 2007 and July 2022. Medical records were retrospectively reviewed regarding variables involving preoperative symptoms, rhinologic history, etiology, surgical techniques, and the outcome of surgery. In addition, features of NSP were objectively evaluated using computed tomography scans.
The overall success rate of NSP repair was 64.3% (54 of 84). Nasal obstruction (79.8%), crusting (34.5%), and epistaxis (27.4%) were frequent preoperative symptoms. Iatrogenic injury from previous nasal surgery (70.2%) was the most common cause. The average size of NSP on preoperative CT was 9.53 ± 6.68 mm. Patients with incomplete NSP closure had significantly larger perforations (12.21 ± 7.92 mm) than those with successful closure (8.04 ± 5.41 mm) preoperatively ( = .005). Patients with smoking history (OR = 2.971, 95% CI 1.170-7.548, = .020) and NSP repair with combined rhinoplasty (OR = 3.811, 95% CI 1.401-10.370, = .007) were more likely to experience incomplete closure. Patients whose perforations were reinforced with interposition graft were more likely to result in successful repair (OR = 6.752, 95% CI 2.496-18.262, < .001). The bilaterality of mucosal flap coverage, surgical approach, types of mucosal flap and interposition graft, perforation shape, mucosal thickness around perforation, and distance from the nasal floor were not significantly related to the surgical outcome.
Significant factors affecting the outcome of NSP repair were patient's smoking status, combined rhinoplasty, application of interposition graft, and perforation size.
鼻中隔穿孔（NSP）修复是一项具有挑战性的手术，适用于对保守治疗无效的有症状的 NSP 患者。本研究旨在通过分析一位外科医生连续进行的 NSP 修复手术，评估手术成功率并确定影响手术结果的因素。
我们纳入了 2007 年 11 月至 2022 年 7 月期间，由同一位外科医生（Y.J.J.）进行 NSP 手术修复的 84 例 NSP 患者。回顾性分析了与术前症状、鼻科病史、病因、手术技术以及手术结果相关的变量。此外，还使用计算机断层扫描（CT）对 NSP 的特征进行了客观评估。
NSP 修复的总体成功率为 64.3%（54/84）。术前常见症状包括鼻塞（79.8%）、结痂（34.5%）和鼻出血（27.4%）。医源性损伤（70.2%）是最常见的病因。术前 CT 显示 NSP 的平均大小为 9.53±6.68mm。NSP 未完全闭合患者的穿孔（12.21±7.92mm）明显大于成功闭合患者（8.04±5.41mm）（=0.005）。有吸烟史的患者（OR=2.971，95%可信区间 1.170-7.548，=0.020）和接受联合鼻整形术的 NSP 修复患者（OR=3.811，95%可信区间 1.401-10.370，=0.007）更有可能出现不完全闭合。使用间置物移植加固穿孔的患者更有可能成功修复（OR=6.752，95%可信区间 2.496-18.262，<0.001）。黏膜瓣覆盖的双侧性、手术入路、黏膜瓣和间置物的类型、穿孔形状、穿孔周围黏膜的厚度以及距鼻底的距离与手术结果无显著相关性。
影响 NSP 修复结果的重要因素是患者的吸烟状况、联合鼻整形术、间置物的应用以及穿孔大小。
