Abstract
Purpose
The greater palatine artery (GPA) is one of the main vessels supplying the nasal septum. We recently described a novel technique to reconstruct a nasal septal perforation (NSP) using a GPA flap. This radiological study explores the feasibility and limits of using a GPA flap for an anterior NSP repair.
Methods
We describe our technique for repairing anterior-most NSP. Radiological measurements of the GPA flap and their limits were analysed. Additionally, a cohort of four patients who underwent reconstruction of a NSP with a GPA flap was included.
Results
The radiological study of 150 nasal cavities showed a 31.5 ± 2.7 cm2 maximum flap area. Taking into account the retraction process (30%), the remaining area was 22.0 ± 1.9 cm2. The septal area anterior to the GPA was 6.1 ± 2.1 cm2. The septal portion of the flap was larger than the area anterior to the GPA pedicle in all cases. Complete NSP repair was achieved in four patients. All cases of NSP remained closed during the follow-up.
Conclusion
The unilateral GPA pedicled flap is a useful technique suitable for the reconstruction of anterior-most perforations that are difficult to cover with other endonasal techniques.
References
Morera Serna E, Ferrán de la Cierva L, Fernández MT, Canut SQ, Mesquida JA, Purriños FJG (2017) Endoscopic closure of large septal perforations with bilateral Hadad-Bassagasteguy flaps. Eur Arch Otorhinolaryngol 274(3):1521–1525
Oberg D, Akerlund A, Johansson L, Bende M (2003) Prevalence of nasal septal perforation: the Skövde population-based study. Rhinology 41(2):72–75
Gold M, Boyack I, Caputo N, Pearlman A (2017) Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging 20(43):80–82
Pereira C, Santamaría A, Langdon C, López-Chacón M, Hernández-Rodríguez J, Alobid I (2018) Nasoseptal perforation: from etiology to treatment. Curr Allergy Asthma Rep 18(1):5
Li L, Han D, Zhang L et al (2016) Impact of nasal septal perforations of varying sizes and locations on the warming function of the nasal cavity: a computational fluid-dynamics analysis of 5 cases. Ear Nose Throat J 95(9):E9–E14
Alobid I (2019) Endoscopic approach for management of septal perforation. Eur Arch Otorhinolaryngol 276(8):2115–2123
Kridel RW (2004) Considerations in the etiology, treatment, and repair of septal perforations. Facial Plast Surg Clin North Am 12(4):435–450
Goh AY, Hussain SS (2007) Different surgical treatments for nasal septal perforation and their outcomes. J Laryngol Otol 121(5):419–426
Friedman M, Ibrahim H, Ramakrishnan V (2003) Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 113:1425–1428
Castelnuovo P, Ferreli F, Khodaei I, Palma P (2011) Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 13(6):411–414
Alobid I, Mason E, Solares CA et al (2015) Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. Radio-anatom Study Rhinol 53(3):235–241
Hanci D, Altun H (2015) Repair of nasal septal perforation using middle turbinate flap (monopedicled superiory based bone included conchal flap): a new unilateral middle turbinate mucosal flap technique. Eur Arch Otorhinolaryngol 272(7):1707–1712
Alobid I, Langdon C, López-Chacon M, Enseñat J, Carrau R, Bernal-Sprekelsen M, Santamaría A (2018) Total septal perforation repair with a pericranial flap: Radio-anatomical and clinical findings. Laryngoscope 128(6):1320–1327
Santamaria-Gadea A, Lopez-Chacon M, Langdon C et al (2018) Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits Rhinology 56(4):386–392
Marino-Sanchez F, Santamaria-Gadea A, Vaca M (2020) Technique to repair a septal perforation endoscopically with a greater palatine artery pedicled flap. Facial Plast Surg Aesthet Med. https://doi.org/10.1089/fpsam.2020.0027(Epub ahead of print)
Teymoortash A, Werner JA (2009) Repair of nasal septal perforation using a simple unilateral inferior meatal mucosal flap. J Plast Reconstr Aesthet Surg 62(10):1261–1264
Teymoortash A, Hoch S, Eivazi B, Werner JA (2011) Experiences with a new surgical technique for closure of large perforations of the nasal septum in 55 patients. Am J Rhinol Allergy 25(3):193–197
Schultz-Coulon HJ (2005) Three layer repair of nasoseptal defects. Otolaryngol Head Neck Surg 132(2):213–218
Cogswell LK, Goodacre TEE (2000) The management of nasoseptal perforation. Br J Plast Surg 53:117–120
Alobid I, Enseñat J, Mariño-Sánchez F, de Notaris M, Centellas S, Mullol J, Bernal-Sprekelsen M (2013) Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors. Neurosurgery 72(4):540–546
Caicedo-Granados E, Carrau R, Snyderman CH et al (2010) Reverse rotation flap for reconstruction of donor site after vascular pedicled nasoseptal flap in skull base surgery. Laryngoscope 120(8):1550–2155
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Figures: MV, FMS. Radiological measurements: ASG, IA. Surgeries: FMS, ASG. Study design: FMS, ASG, GS. Manuscript drafting and critical review: ASG, FMS, MV, GS, IA.
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Santamaría-Gadea, A., Vaca, M., de los Santos, G. et al. Greater palatine artery pedicled flap for nasal septal perforation repair: radiological study and case series. Eur Arch Otorhinolaryngol 278, 2115–2121 (2021). https://doi.org/10.1007/s00405-020-06230-1
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DOI: https://doi.org/10.1007/s00405-020-06230-1