Outcome of surgical closure of nasal septal perforation.

OBJECTIVE: To assess success rates and symptom control after surgical treatment of nasal septal perforation.
METHOD: A prospective study was undertaken of 28 consecutive patients with symptomatic nasal septal perforation treated surgically by one surgeon between 2005 and 2007. All patients underwent an open rhinoplasty approach with bilateral superior and inferior nasal mucosal advancement flaps and acellular porcine collagen placed in between. Symptom severity was assessed pre- and post-operatively using a validated visual analogue score. The nasal valve angle was assessed pre- and post-operatively by two independent assessors.
RESULTS: Patients comprised 12 women and 16 men, with a mean age of 45 years (range: 21-76). The mean follow up was 16 months (range: 6-24). The mean vertical and horizontal diameters of the perforations were 22 mm (range: 10-35) and 27 mm (range: 10-37), respectively. Twenty-seven (96 per cent) patients had complete closure of nasal septal perforation. There were statistically significant differences between the pre- and post-operative mean visual analogue scale scores for epistaxis (p < 0.001), crusting (p < 0.001), whistling (p < 0.001) and nasal obstruction (p < 0.001). Epistaxis, crusting and whistling resolved in all patients, and 92 per cent reported improvement in nasal blockage.
CONCLUSION: Closure of nasal septal perforation using an open rhinoplasty approach with nasal mucosal advancement flaps and a porcine collagen sandwich is a pertinent and reliable technique for the management of nasal septal perforation.