Surgical considerations in the open rhinoplasty approach to closure of septal perforations.

Repair of nasoseptal perforations is a difficult problem for the otolaryngologist. Recently, there has been an increased incidence among patients, particularly with the rise in cocaine abuse and trauma. The variety of proposed methods of repair points to the lack of a definitive solution for successful surgical treatment of nasoseptal perforations. Successful septal perforation repairs using an open rhinoplasty approach with bipedicled mucoperichondrial flaps and temporal fascia grafts were achieved in eight of nine patients in a series. Resident otolaryngologists in training were the primary surgeons in all nine patients. The open rhinoplasty approach affords better exposure to the septal perforation than does a closed technique, and it facilitates the elevation of mucoperichondrial flaps on all sides of the perforation. This method also allows the surgeon access to perform a limited concurrent rhinoplasty when indicated. The open rhinoplasty approach is ideally suited for teaching the technique of large septal perforation closure in surgical training programs. The surgical considerations in using this method are discussed.