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Total septal perforation repair with a pericranial flap: Radio‐anatomical and clinical findings
Author(s) -
Alobid Isam,
Langdon Cristóbal,
LópezChacon Mauricio,
Enseñat Joaquim,
Carrau Ricardo,
BernalSprekelsen Manuel,
Santamaría Alfonso
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26966
Subject(s) - nasal septum , medicine , perforation , cadaveric spasm , cadaver , deviated nasal septum , surgery , radiological weapon , anatomy , nose , punching , materials science , metallurgy
Objectives/Hypothesis Endonasal surgeries are the primary cause of septal perforation (SP). However, trauma, inflammation, infections, neoplasms, or abuse of inhaled drugs can also cause SP. Septal repair is indicated in patients who experience nasal obstruction, crusting, intermittent epistaxis, purulent discharge, or nasal whistling and in those who fail conservative treatment. Multiple approaches have been suggested to repair the SP; however, none has been universally adopted. This study explores the feasibility of repairing a total SP using the pericranial flap (PCF). Study Design Anatomical cadaver and radiological study plus case study. Methods Total nasal septectomy and endoscopic reconstruction with a PCF was performed in 12 injected cadaveric specimens. Maximum length and area of the nasal septum and the PCF were measured in 75 computed tomography scans. Based on the anatomical study and the radiological measurements of the cadavers, one patient underwent total nasal septum repair. Results Anatomic measurements showed that the nasal septum has a mean length of 5.8 ± 0.7 cm, whereas the PCF was on average 18.4 ± 1.3 cm long (mean surface area 121.6 ± 17.7 cm 2 ). Radiological measurements revealed that the PCF should provide a surface area of 40.9 ± 4.2 cm 2 to account for the total septal area and an additional 30% to account range for potential scar retraction. For total septum repair, the distal edge of the PCF had to be placed 0.8 ± 2.0 cm (3.4 ± 8.7°) from the adopted reference point (vertical projection of the external ear canal). Total septal reconstruction was performed successfully in one patient without complications. Conclusions Radio‐anatomical data and a case study demonstrate that a PCF allows complete endoscopic repair of the nasal septum. Level of Evidence NA. Laryngoscope , 128:1320–1327, 2018