This Belgian retrospective observational study looked at the success rate and predictive factors for success when bilateral advancement flaps were used via an external approach. In total, 111 patients were included in the study over a 16-year period. The mean follow-up was 2.5 months (range 0.5-12 months). The surgical technique involved using an inferiorly based bipedicle advancement flap and, if necessary (due to inadequate mobility of the flap) a superiorly based bipedicle advancement flap.

At the end of follow-up, successful closure of the septal perforation was achieved in 67% of patients, with 12% having incomplete closure, and 21% having a residual nasoseptal perforation.

The only significant factor in determining successful closure of the perforation was the initial size of the perforation. The patients were divided into small (<1cm), medium (1-1.9cm) and large-sized (≥2cm) perforations and found to have success rates of 82%, 67% and 15% respectively. Interestingly, of those patients who had a residual perforation, 44% had no postoperative symptoms. Nasal septal perforation closure is a notoriously difficult surgical procedure with variable success, but the authors have suggested a surgical technique that appears to have reasonably good success rates for small and medium-sized (<2cm) perforations. However, the authors concede that for larger-sized perforations alternative surgical techniques should be considered.

Surgical closure of nasoseptal perforations: predictive factors for success.
Dierickx C, Van Gerven L, Jorissen M.
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Sunil Sharma

Alder Hey Children's Hospital, UK.

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