Rhinoplasty with Concurrent Repair of Septal Perforation

Overview

A septal perforation is a hole through the wall dividing the two sides of the nose. Repairing one at the same time as reshaping the nose is described as challenging, because the tissue moved to close the hole and the tissue moved to change the shape come from the same limited supply. The review covers workup, planning and the techniques that can be combined.

Sections of note

• Article type: narrative review. No patient numbers, closure rates or follow up data are reported.
• Planning foundation: the cause of the perforation, its current status, and overall nasal health.
• Preoperative evaluation should identify where the airway is blocked, define aesthetic goals and judge whether the combined procedure is feasible.
• The two operations share common maneuvers, which is what makes combining them possible.
• Closure techniques said to combine readily with rhinoplasty: interposition grafting and intranasal mucosal rotational advancement flaps.
• Those flaps exert forces on the nose that can have aesthetic or functional consequences.
• Rhinoplasty maneuvers in any third of the nose can affect the tension or the amount of lining available for closure.

What it means for a patient

• The lining inside the nose is the limiting resource. Using it to close a hole leaves less available for reshaping, and the reverse also applies.
• Closing a perforation can pull on the nose and change its shape, so the two goals must be planned together rather than in sequence.
• The abstract reports no closure success rates, so the odds of the hole staying closed after a combined operation are not stated here.
• The review frames combined surgery as feasible but demanding, requiring careful workup and postoperative care.

Why this paper matters

Septal perforations cause crusting, bleeding, whistling and blockage, and patients who have one often also want their nose reshaped. Doing both at once avoids a second operation but risks compromising each. Which combinations of techniques give the best closure rates is not established here.

Terms

• Septal perforation: a hole through the wall dividing the two sides of the nose.
• Nasal mucosa: the moist lining inside the nose.
• Interposition graft: tissue placed between the two lining layers to seal a hole.
• Rotational advancement flap: lining moved from a neighboring area, kept attached to its blood supply.
• Etiology: the underlying cause of a condition.