Long-term Results of Combined Rhinoplasty and Septal Perforation Repair

Abstract

IMPORTANCE Combined rhinoplasty and septal perforation repair is a technically challenging procedure, and few studies have reported the outcomes. OBJECTIVE To present the long-term surgical results of rhinoplasty with concurrent septal perforation repair. DESIGN, SETTING, AND PARTICIPANTS This retrospective study included 17 patients who underwent rhinoplasty with concurrent septal perforation repair at a tertiary academic medical center from March 2005, through March 2015. Patients had a mean postoperative follow-up duration of 50.9 months. The etiology of the deformity, presenting symptoms, perforation size, intraoperative surgical techniques, and complications were analyzed. Final follow-up was completed on March 31, 2015. MAIN OUTCOMES AND MEASURES Postoperative subjective (telephone survey of patient satisfaction) and objective (Objective Rhinoplasty Outcome Score) patient satisfaction and endoscopic nasal cavity examination at the last follow-up. RESULTS Among the 17 patients (14 men; 3 women; mean [SD] age, 40 [16] years), 12 (71%) had previously undergone septoplasty and/or septorhinoplasty, 4 (24%) had nasal trauma, and 1 (6%) had an unknown cause. The main aesthetic reasons for rhinoplasty were a saddle nose deformity (10 patients [59%]) and deviated nose related to a previous surgery or trauma (5 patients [29%]). The functional reasons for surgery included nasal obstruction (14 patients [82%]) crusting (2 patients [12%]), epistaxis (1 patient [6%]), and whistling (1 patient [6%]). The perforation size varied from 2 to 30 mm, with a mean of 14.3 mm. Surgery was performed through the open rhinoplasty approach. Perforations were first closed with an advancement flap in 6 patients, rotation flap in 6 patients, a combination of both in 4 patients, and a combination of advancement flap and free mucosal graft in 1 patient, with or without interposition grafts. Rhinoplasty was performed with various grafts, maneuvers, and septal reconstruction. Complete closure with symptom relief was achieved in 15 patients (88%). The mean objective score evaluating the rhinoplasty results was 3.4 (on a scale of 0-4, where 3.4 is good to excellent). No serious complications occurred after surgery. CONCLUSIONS AND RELEVANCE Concurrent rhinoplasty and nasal septal perforation repair is a safe and effective option when necessary. The open rhinoplasty approach facilitated septal perforation closure, whereas septal perforation repair did not affect the surgical result of rhinoplasty.