Endoscopic closure of large septal perforations with bilateral Hadad–Bassagasteguy flaps

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• 作者：Eduardo Morera Serna…
• 关键词：Large septal perforation ; Haddad flap ; Schneiderian mucosa
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：274
• 期：3
• 页码：1521-1525
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Otorhinolaryngology; Neurosurgery; Head and Neck Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：1434-4726
• 卷排序：274

文摘

Surgical closure of nasal septal perforations is one of the most challenging procedures in nasal surgery. Defects greater than 2 cm are especially difficult to repair with the traditional approaches due to the challenges of mobilizing enough mucosa to close big gaps, and avoiding airway stenosis in the process. We present a new technique to endoscopically close major septal perforations using bilateral Hadad–Bassagasteguy flaps. Four consecutive patients with septal perforations greater than 2 cm were operated at our institution. Bilateral Hadad–Bassagasteguy flaps were endoscopically raised, one of them above the defect and the other one below it, and rotated to partially cover the defect on each side. A deep temporalis fascia graft was sandwiched between the two flaps to provide a scaffold for schneiderian mucosa growth. Both flaps were covered with a silicone sheet for 3 weeks. A complete closure of the defect was accomplished in three of the four patients; partial closure was achieved in the other. Nasal crusting, epistaxis, and nasal breathing improved in all patients. Large defects of the nasal septum may be closed in selected cases by rotation of bilateral pedicled septal mucosal flaps partially covering the defect area, followed by secondary healing of the nasal mucosa over an autologous graft acting as an epithelial scaffold.