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Bone and temporal fascia graft for the closure of septal perforation

Published online by Cambridge University Press:  29 June 2007

David Núñ;ez-Fernández ,
Jan Vokurka  and
Viktor Chrobok
David Núñ;ez-Fernández*
Affiliation:
Department of Otorhinolaryngology, Head nad Neck Surgery, University Hospital of Hradec Králové, Charles University Faculty of Medicine in Hradec Králové, Echegararay Medical Center, Mexico city, Mexico. Department of Czech Republic and Otolaryngology Unit, Echegaray Medical Center, Mexico City, Mexico.
Jan Vokurka
Affiliation:
Department of Otorhinolaryngology, Head nad Neck Surgery, University Hospital of Hradec Králové, Charles University Faculty of Medicine in Hradec Králové, Echegararay Medical Center, Mexico city, Mexico.
Viktor Chrobok
Affiliation:
Department of Otorhinolaryngology, Head nad Neck Surgery, University Hospital of Hradec Králové, Charles University Faculty of Medicine in Hradec Králové, Echegararay Medical Center, Mexico city, Mexico.
*
Address for correspondence: David Núñez-Fernández, M.D., Unidad de Otorrinolaringologfa, Blvd. M.A. Camacho 959-103, Bosques de Echegaray, 53310, Naucalpan, Edo. de México, Mexico. e-mail: rhinogroup@yahoo.com
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Abstract

Objectives

To assess the reliability of temporal fascia and bone graft for the closure of septal perforation.

Study design

Prospective longitudinal non-randomized.

Methods

The repair of septal perforation was performed using endonasal dissection; suture of the borders of the perforation on at least one side, and interposition of a graft of temporal fascia with bone, either a perpendicular plate of ethmoid (six) if available or mastoid cortex (three) if not.

Results

All patients had closure without re-perforation. Eight out of nine patients had complete closure of the perforation (88.8 per cent). These patients had perforations of less than 3 cm in diameter. The ninth patient had a perforation of more than 3 cm diameter (3.5 × 2.5 cm), and obtained a closure of about 80 per cent of the original perforation. The remaining perforation was in the posterior part of the nose. The patient was relieved of his symptoms (crusting and bleeding). This incomplete closure was most probably due to migration of the graft immediately after surgery. There was no morbidity of the donor site or the ear in the mastoid cortex graft group of patients. This is to our knowledge the first report of the use of the mastoid cortex as a graft in septal perforation.

Conclusions

We consider that the graft of temporal fascia with bone is very reliable, and the use of bone ensures closure while avoiding the complications of a lax septum in large perforations. The technique is suitable for perforations up to 2.5 cm diameter. Perforations larger than 3 cm in diameter are more difficult to close, but closure of the anterior part of the perforation will relieve the patient from the most annoying symptoms.

Keywords

Nasal septumFistulaSurgery, operative

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 112 , Issue 12 , December 1998 , pp. 1167 - 1171
Copyright
Copyright © JLO (1984) Limited 1998

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