Karlan M S, Ossoff R, Christu P
Arch Otolaryngol. 1982 Jul;108(7):433-6. doi: 10.1001/archotol.1982.00790550037009.
Reconstruction of large nasoseptal perforations is often dismissed as surgically unfeasible. The insertion of polymer prostheses for amelioration of symptoms has substituted for surgical repair. Despite the important progress that has recently been made, troublesome defects, eg, the repair of 2 x 4-cm losses, are considered surgically unapproachable. One of us (M.S.K.), during the past seven years, has treated these defects with techniques developed in skull base surgery and, more recently, in maxillofacial and craniofacial surgery. The wide exposure achieved has permitted the use of large intranasal flaps for one-step repair. Photographs, graphic illustrations, and cadaver dissections are used to present the techniques. The literature is reviewed. Clinical material is reviewed, and special consideration is given to the problems of intranasal scarring and flap blood supply. The techniques used represent an evolutionary synthesis and implementation of surgical principles rather than a new technique. Nevertheless, the tools are now at hand for all to approach these large perforations with confidence.
大型鼻中隔穿孔的重建通常被认为在手术上不可行。插入聚合物假体以改善症状已替代了手术修复。尽管最近取得了重要进展，但棘手的缺损，如2×4厘米大小的缺损修复，仍被认为在手术上无法解决。我们中的一人（M.S.K.）在过去七年中，采用了颅底外科以及最近颌面和颅面外科所开发的技术来治疗这些缺损。所实现的广泛暴露使得能够使用大型鼻内皮瓣进行一步修复。文中通过照片、图示和尸体解剖来展示这些技术。同时对相关文献进行了综述。对临床资料进行了回顾，并特别考虑了鼻内瘢痕形成和皮瓣血供的问题。所使用的技术代表了手术原则的逐步综合与应用，而非一项新技术。然而，现在大家都已掌握了工具，能够自信地处理这些大型穿孔。
