Background:
Surgical closure of septal perforations remains a challenging task for the head and neck surgeon. In the literature, many different surgical techniques have been described. The bridge flap technique described by Schultz-Coulon is considered as the standard procedure. A bilateral coverage of septal perforations is supposedly superior to an unilateral coverage. We aim to report on our experience with Castelnouvo's unilateral septal rotation flap based on the anterior ethmoidal artery.
Material and methods:
From 09/2016 till 07/2017, five patients with an iatrogenic, anterior septal perforations underwent an endoscopic surgical closure using Castelnouvo's flap. Previous conservative treatment efforts with nasal ointments, sprays, or saline douching were unsuccessful. Septal buttons were not tolerated in four cases. The perforations had an average size of 12.75 mm (8 – 23 mm). All patients suffered from recurrent epistaxis, nasal obstruction or crusting. After surgery, all patients underwent clinical, endoscopical and rhinomanometric examinations over a follow-up period of 12 months.
Results:
All patients claimed a better nasal breathing with significant improvement of their previous clinical symptoms. No epistaxis was observed postoperatively. A complete closure of the septal perforation could be achieved intraoperatively in all cases. The mean postoperative follow-up period was 6,5 months (range 6 – 12 months). In one case, a recurrence of a small nasal septal perforation was observed without any relevant clinical symptoms.
Conclusion:
This operation technique is a promising and valuable alternative for closure of nasal septal perforations if no additional septumplasty oder rhinoplasty is necessary. Further long-term follow up studies on a larger cohort are necessary.
