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Medialization of Anterior Retrogressed Caudal Septal (MARCS) Flaps for the Closure of a Septal Cartilage Perforation
Marc V. Orlando, MD (1)
Ananth S. Murthy, MD, FACS (2)
(1) Summa Akron City Hospital, Akron, OH
(2) Akron Children's Hospital, Akron, OH
2015-03-12
Presenter: Marc V. Orlando, MD
Affidavit:
I attest that this material has not been previously published.
This original work was jointly concieved by the authors and Dr Orlando did 90% of the work involved in bringing this research to submission.
Douglas S Wagner, MD
Program Director, Summa Health System
Director Name: Douglas S. Wagner, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Treatment of septal perforations is a challenging endeavor. High relapse rates exist, with an incidence of perforation recurrence ranging between 30% to 70%. Operative correction often requires wide dissection, recruitment of surrounding tissues, and placement of a septal spacer in order to avoid opposing suture lines. A brief case description of a technique that incorporates these principles is presented. This method can be used for small to medium-sized perforations, and avoids external incisions.
Case description: A 7 year-old male presents with a septal perforation after battery lodgment in his nostril. Despite previous surgical attempts, physical exam reveals a persistent 15mm perforation 1cm posterior to the caudal septum. Through an upper gingivobuccal sulcus incision and subperiosteal maxillary dissection, the lateral vestibular mucosa and nasal floor are elevated in continuity. The septal mucoperichondrium is separated and advanced by en bloc elevation with nasal floor mucosa that is retrogressed medially to close the perforation in a straight, tension-free bilateral closure over an interposition graft of human acellular dermal matrix.
Conclusion: Sublabial access for medialization of anterior retrogressed caudal septal (MARCS) flaps is a safe and effective alternative for repair of chronic, anterior nasal septal perforations without compromising facial aesthetics by introducing external scars from alatomy or open rhinoplasty incisions, or risking facial growth disturbances in the pediatric population.
