Endonasal Septal Perforation Repair: Free Mucosal Graft With Lyoplant® Bioscaffold

Abstract

There are many causes of nasal septal perforation (NSP) including nasal surgery, trauma, cauterization, nasal packing, vasculitis, and nasal drug abuse. Infectious and inflammatory processes, such as Wegener’s granulomatosis, collagen vascular disease, tuberculosis and syphilis could also cause NSP. Among them, nasal surgery including septoplasty and rhinoplasty is the most common cause of NSP. It is associated with nasal obstruction, crusting, rhinorrhea, recurrent epistaxis, whistling sound, parosmia, and neuralgia which result in poor quality of life. NSP is formed when both side mucoperichondriums of nasal septum are loss and blood supply is disrupted. Therefore, condition of mucosa, cartilage, and blood supply of nasal cavity should be considered when repair of NSP. Various surgical techniques have been introduced to repair the NSP depending on the size of perforation and condition of mucosa and cartilage. Small (less than 0.5 cm) and medium size (0.5 to 2 cm) defects could be closed endonasally by free mucosal graft or advancement flap with or without interposition graft including autologous and allograft. Inferior turbinate free mucosal graft demonstrated satisfiable results with a success rate between 83% and 88% in case of small perforation, but it is difficult to fix to the correct perforation site and its bulk could cause nasal obstruction. Mucosal advance flap usually requires the wide dissection extent of septal mucosa which could result in delayed healing and time spending. Rotational mucosal flap with inferior turbinate is the most popular and effective technique for small to medium size perforation, but symptomatic perforations usually too anterior to reach the inferior turbinate rotational flap. In addition, inferior turbinate rotational flap could cause intranasal adhesions between the septum and turbinate and nasal obstruction due to flap bulk. To overcome those disadvantages, we tried to perform the turbinate free mucosal graft with bioscaffold (Lyoplant, pISSN 1229-1498 / eISSN 2384-4361