Repair of nasal septal perforation with different intranasal flap techniques and their outcomes

Yıl 2009, Cilt: 19 Sayı: 5, 232 - 238, 23.10.2009

Ahmet İslam Sevim Felek Hatice Çelik Necmi Arslan İlknur Haberal Can Haldun Oğuz

Öz

Objectives: The aim of this study was to reveal the efficacy of different nasal mucosal flap techniques in the repair of nasal septal perforation. Patients and Methods: Between April 2006 and May 2009 21 patients 12 males, 9 females; mean age 36.6±12.7 years; range 17 to 60 years with the complaints of nasal obstruction, bleeding, crusting, whistling during inspiration, and pain and in whom septum perforation was detected were operated on and they were included in this study. The patients were followed-up for an average of 16.9 months 3 to 35 months . Cross-stealing technique was performed on 11 patients while advancement flap was performed on three patients and rotation flap was performed on seven patients. Patients were followed-up for at least three months before the evaluation of the postoperative results. Results: Complete closure was observed in 16 out of 21 patients 76.2% and partial closure in one patient 4.8% . In four patients 19% perforation was not closed and its size remained unchanged. Conclusion: In the literature, many different surgical techniques have been described for the repair of nasal septal perforation. The main aim of the repair is not only the closure of perforation but also the restoration of normal function and physiology in the nose. In order to achieve this, the most physiologically and anatomically suitable method is the closure of nasal septal perforation with three layers composed of two mucoperichondrial flaps and one interpositional graft. Although cross-stealing technique may be an anatomically and physiologically feasible option for the closure of smallmiddle sized perforation located anteriorly, the highest success rates are obtained with advancement and rotation flaps when the location and size of perforation are considered.

Anahtar Kelimeler

Advancement flap, cross-stealing technique, endonasal approach, interpositional graft, nasal mucoperichondrial flap, nasal septal perforation, rotation flap

Nazal septal perforasyonun farklı intranazal flep teknikleri ile onarımı ve sonuçları

Öz

Amaç: Bu çalışmada nazal septal perforasyon onarımında farklı nazal mukozal flep tekniklerinin etkinliği ortaya kondu.Hastalar ve Yöntemler: Nisan 2006-Mayıs 2009 tarihleri arasında burun tıkanıklığı, kanama, kabuklanma, nefes alırken ıslık sesi oluşması ve ağrı gibi yakınmalarla başvuran, muayenesinde septum perforasyonu saptanan ve ameliyat edilen 21 hasta 12 erkek, 9 kadın; ort. yaş 36.6±12.7 yıl; dağılım 17-60 yıl çalışmaya alındı. Hastalar ameliyat sonrası ortalama 16.9 ay 3-35 ay takip edildi. Ameliyatta 11 hastada cross-stealing, üç hastada ilerletme ve yedi hastada rotasyon flebi ile onarım tekniği uygulandı. Ameliyat sonrası sonuçların değerlendirilmesinden önce hastalar en az üç ay süreyle takip edildi.Bulgular: Yirmi bir hastanın 16’sında %76.2 tam kapanma, birinde %4.8 parsiyel kapanma gözlendi, dört hastada %19 ise perforasyonda kapanma sağlanamadı ve perforasyon boyutları değişmedi.Sonuç: Nazal septal perforasyonun onarımında literatürde birçok farklı cerrahi teknik tanımlanmıştır. Onarımın temel amacı sadece perforasyonun kapatılması değil burnun normal fonksiyon ve fizyolojisinin de sağlanmasıdır. Bunun için iki mukoperikondriyal flep ve bir interpozisyonel greftden oluşan üçlü tabaka ile nazal septal perforasyonun kapatılması, anatomik ve fizyolojik olarak en uygun yöntemdir. Cross-stealing teknik, anteriyor küçük ve orta büyüklükte perforasyonların kapatılmasında anatomik ve fizyolojik olarak uygun bir seçenek olsa da, perforasyonun yeri ve büyüklüğü hesaba katıldığında en başarılı sonuçların ilerletme ve rotasyon flepleri ile sağlandığı görülmektedir

Anahtar Kelimeler

İlerletme flebi, cross-stealing teknik, endonazal yaklaşım, interpozisyonel greft, nazal mukoperikondriyal flep, nazal septal perforasyon, rotasyon flebi

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