4.DISCUSSION
The study findings revealed a successful rate of closure of NSPs with
our surgical technique. NSPs can lead to various nasal symptoms.
Non-surgical therapeutic options are available for overcoming these
symptoms in patients who refuse surgery or who are unsuited, such as
nasal washing solutions, moisturizer sprays, and nasal septal button
application. However, the only means of entirely and permanently
eliminating symptoms is surgery. Several different techniques have been
described for surgical repair. Surgical success rates are closely linked
to the experience of the surgeon and to the size and site of the NSP.
Success rates range between 78% and 93%, depending on the size of the
perforation5.
The techniques employed for the repair of NSPs have increased
considerably in recent decades. Middle concha and lateral nasal wall
posterior pediculated flaps are an appropriate choice for posteriorly
located perforations. However, since access to the colummella is
difficult, they are not suitable for anteriorly located
perforations6. Lower concha flaps can be successfully
employed in the closure of large perforations. However, nasal
obstructions associated with excess tissue can be observed in this flap
technique. In addition, secondary operations for severing the pedicle
are required in these flap techniques7. Although nasal
floor flaps are an appropriate option for inferior perforations, they
are not suitable for superiorly located perforations1.
Reperforation rates are lower in operations in which the perforation is
closed using bilateral and interposition graft techniques, although the
Swell body problem necessitating a second operation may be
encountered8. Pericranial flaps are used in the
closure of very large perforations. However, morbidity rates are high in
this technique, and it is disadvantageous in terms of nasal functions
due to the absence of nasal ciliary activity9.
All these surgical techniques have their own advantages and
disadvantages. A broad surgical perspective is therefore essential for
the repair of NSPs with different characteristics. The closure of NSPs
is easier with our technique. The most important advantages of this
technique are ease of application and the fact that it does not require
secondary operations. The crescent-shaped incision made over the
perforation in this technique allows the flap to move freely under the
effect of gravity, thus facilitating suturing. Moreover, it allows a
larger flap to be obtained in larger perforations by extending the
incision in a posterior direction.
The principal disadvantage of our technique is that it cannot be
employed in perforations located in close proximity to the nasal roof
and that extending to the membranous nasal septum, since it will not be
possible to create the flap described.