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.
