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Upper Lateral Cartilage Mucosal Flap Enables the Successful Closure of Larger Septal Perforations

by Linda Kossoff •

What are the surgical technique and closure outcomes of larger septal perforation repair incorporating mucosa from undersurface of the upper lateral cartilage into a superiorly positioned advancement flap?

BOTTOM LINE

The ventral surface of the upper lateral cartilage can provide additional mucosa for incorporation into a superior advancement flap to achieve successful closure for larger septal perforations.

BACKGROUND: Frequently published surgical techniques for closure of nasal septal perforations use bilateral or unilateral nasal mucosal flaps. Repairs using nasal mucosa are considered the most physiologic, but flap procedures are technically difficult and outcome has not been standardized. Regardless of the procedure used, a major perforation closure determinant is defect size.

STUDY DESIGN: Retrospective case series.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Ariz.

SYNOPSIS: Of 299 patients receiving mucosal flap septal perforation repairs between January 2009 and December 2020, researchers identified 66 who underwent repair using a left-sided upper lateral cartilage mucosal (ULM) flap. Prior septal surgery was the most common (28.8%) etiology, and mean perforation length and height were 18.9 and 14.4 mm, respectively. Patients’ presenting symptoms included crusting (90.9%), obstruction/congestion (89.4%), epistaxis (69.7%), whistling (15.2%), and facial pain/pressure (16.7%). All repairs were performed endonasally using a three-layer repair technique. Authors noted that most septal perforations demonstrate greater horizontal length than vertical height, so attempted closure is well suited to procedures using horizontally oriented flaps superior and/or inferior to the perforation. They also noted that the superior ULM maneuver can add 1 cm of mucosa to the anterior–superior aspect of the repair. Complete perforation closure was noted in 91.2% of patients followed for six months or more. Twelve patients underwent secondary surgery for persistent nasal obstruction. Postoperative dorsal height was noted in seven patients. Study limitations related to postoperative follow-up time and the number of patients with validated outcomes.

CITATION: Bansberg SF, Taylor CM, Howard BE, et al. Repair of large nasal septal perforations using the upper lateral cartilage mucosal flap. Laryngoscope. 2022;132:973-979.