Reconstruction for large septal perforations.
Reconstruction of large nasoseptal perforations is often dismissed as surgically unfeasible. The insertion of polymer prostheses for amelioration of symptoms has substituted for surgical repair. Despite the important progress that has recently been made, troublesome defects, eg, the repair of 2 x 4-cm losses, are considered surgically unapproachable. One of us (M.S.K.), during the past seven years, has treated these defects with techniques developed in skull base surgery and, more recently, in maxillofacial and craniofacial surgery. The wide exposure achieved has permitted the use of large intranasal flaps for one-step repair. Photographs, graphic illustrations, and cadaver dissections are used to present the techniques. The literature is reviewed. Clinical material is reviewed, and special consideration is given to the problems of intranasal scarring and flap blood supply. The techniques used represent an evolutionary synthesis and implementation of surgical principles rather than a new technique. Nevertheless, the tools are now at hand for all to approach these large perforations with confidence.