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Medialization and Retrogression of Caudal Septal Flaps for the Closure of a Septal Cartilage Perforation
Kenny Quang, MD
Ananth Murthy, MD
Summa Health Systems
2024-01-30
Presenter: Kenny Quang
Affidavit:
100% of work is original to resident
Director Name: Ananth Murthy
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Treatment of septal perforations is a challenging endeavor. Recurrence ranges from 30% to 70%. Operative correction often requires wide dissection, local flaps, and septal spacers. The pediatric population poses an even greater challenge given the limited size for visualization and less tissue available to transfer. The most common and successful methods involve endoscopic and open rhinoplasty techniques.
We present a midfacial degloving approach via a transoral, gingivobuccal approach. Our approach does not require an endonasal component or external incisions.
Methods:
Two cases using this technique from a single surgeon and institution.
An upper gingivobuccal sulcus incision is carried down to periosteum. A subperiosteal dissection is then performed elevating the lateral vestibular mucosa and nasal floor in continuity. Dissection is performed to the level of the septal perforation. A circumferential incision is made around the perforation followed by separation of the mucoperichondrium bilaterally. By en bloc elevation, the mucosa are retrogressed medially, closing the perforation in a straight, tension-free bilateral closure. An interposition graft of human ADM is then inset. The gingivobuccal sulcus incision is closed, and silicone nasal splints placed using transeptal suture fixation.
Results:
Two patients underwent this technique for repair of medium sized anterior nasal septal perforations. Follow up was for 49 months and 8 months, respectively, without any recurrence.
Conclusion:
Sublabial access for medialization and retrogression of caudal septal (MARCS) flaps is a safe and effective alternative for repair of chronic, anterior nasal septal perforations without external scars or risking facial growth disturbances in the pediatric population.
