Rare But Effective Techniques I Use in Septum Perforations
Prof. Dr. Gediz Murat Serin
Septum perforation (septal perforation), which is the formation of a hole in the nasal septum, can cause serious complaints for patients both functionally and aesthetically. Whistling sound during breathing, nosebleeds, dryness, crusting, and smell disorders are among the primary symptoms. Although many surgical methods have been described for closing perforations, there are also techniques that we rarely use in some special cases but yield quite effective results.
In this article, I would like to share two special techniques that I apply to a limited patient group in my practice but have a high success rate:
- Lip mucosa flap
- Inferior turbinate mucosa flap
Using Lip Mucosa Flap
This is a method I prefer especially for anteriorly located, small-sized perforations that are due to previous surgery. A flap prepared from the mucosa on the inner surface of the upper lip is slid to the perforation area inside the nose to close the hole.
Advantages
- Lip mucosa is a flexible tissue with good vascularization.
- It easily reaches perforations close to the anterior region and provides strong coverage.
- It does not leave a visible scar and does not bother the patient aesthetically.
Disadvantages
- It is not sufficient alone for large perforations.
- There may be temporary sensitivity and tension in the lip.
- Most of the time, I add fascia or cartilage graft underneath to increase success.
For this reason, I use lip mucosa flap mostly in small and anterior perforations. Nevertheless, when the right patient is selected, the results are quite satisfactory.
Using Inferior Turbinate Mucosa Flap
The turbinate tissues located inside the nose constitute an important source due to both their anatomical proximity and the durability of their mucosa. Turbinate mucosa flaps are quite functional, especially in perforations located in the middle-posterior region.
Advantages
- Since it is taken from inside the nose, no extra incision is required.
- Turbinate mucosa is already a tissue compatible with the nasal environment.
- It can be easily rotated to the perforation area and has a high chance of attachment.
Disadvantages
- If the turbinates have been reduced or previously operated on, this limits usability.
- It may not be sufficient alone for very large perforations.
In my practice, if the structure of the turbinates is suitable, I rarely prefer this method. Most of the time, I combine it with cartilage or fascia grafts to support the flap.
Conclusion
Each patient’s septum perforation is unique. The location and size of the perforation, the condition of intranasal tissues, and the surgeries the patient has previously undergone are determinants in technique selection. Although lip mucosa flap and inferior turbinate mucosa flap are methods I do not frequently resort to, they provide effective and permanent results with the right indication.
My approach is always to choose the most suitable and reliable method for the patient. Therefore, I successfully apply these two techniques in rare but selected cases.
