The Application And Thinking Of Repairing The Perforation Of Nasal Septum With Pedicle Large Mucoperiosteal Flap

Objective The surgical repair of the large perforation of nasal septum has some difficulties for otolaryngologists.The purpose of this study is to investigate the method of using pedicled septum-nasal floor-lateral nasal wall large mucoperiosteal flap to repair the large perforation of nasal septum under nasal endoscope,analyze and compare the technical adaptation and advantages and disadvantages of various methods of construction.so as to explore a simpler,effective and reliable method.Methods From 2012-2017,8 patients with perforation of nasal septum were admitted to otolaryngology department in our hospital.They were divided into 3 large perforation(> 1.5 * 1.5 cm)and 5 small and medium perforation(< 1.5 * 1.5 cm)according to the perforation size.In 2 cases of large perforation,we used pedicled septum-nasal floor-lateral nasal wall large mucoperiosteal flap to repair.According to the size of perforation,make the suitable flap to cover the perforation,sutured and fixed up.After operation,bilateral nasal cavity was stuffed with Naso Pore and Merocel for 5 days and the cotton ball blocked the anterior nares for 3-4 weeks.All patients was followed for more than 3 months.In another case of large perforation,free temporal myofascial flap was used to repair,after manke a fresh wound aroud the perforation,we selected suitable size free temporal myofascial flap and sutured and fixed up.Postoperative treatment was as above.For 5 cases of small and medium perforation below 1.5 * 1.5 cm,1 case was repaired by pedicled septum-nasal floor-lateral nasal wall flap,1 case was repaired by pedicled inferior turbinate mucosal flap,2 case was repaired by nasal septum mucosal flap,and 1 case was repaired by Abbé lip flap,Postoperative treatment was as above.Results In the above cases,patients repaired by pedicled septum-nasal floor-lateral nasal wall large mucoperiosteal flap were followed up for 3 months,the perforation was healed well and there was no perforation.A case with free temporal myofascial fascia was followed up with a displaced flap and a failed repair.The small and medium perforation of nasal septum was well healed after operation.Comprehensive analysis and comparison,the method of using pedicled septum-nasal floor-lateral nasal wall flap to repair the large nasal septal perforation compared with other surgical repair methods,which had the several advantages,such as large mucosal flap,pedicle,abundant blood supply and no need for second stage pedicle division,and guaranteed the wetness of nasal cavity,and reducing the effect of operation on the normal function of nasal cavity.Conclusion the method of using pedicled septum-nasal floor-lateral nasal wall flap to repair the large perforation of nasal septum is more convenient than other surgical methods.It has high operability and successful rate,and deserve promotion in clinical practice.