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Thomas Romo, III, MD; Robert D. Jablonski, MD; Aaron L. Shapiro, MD; Steven A. McCormick, MD

Arch Otolaryngol Head Neck Surg. 1995;121(3):327-331.

Abstract
Reperforation rates of large, surgically closed nasoseptal perforations remain unacceptably high (30% to 70%). With the advent of newer surgical techniques, including external decortication rhinoplasty and midface degloving, excellent exposure of the intranasal anatomy is afforded. The limiting factor of these approaches is the deficiency of local intranasal mucosal lining, which is used to close large septal perforations. The paucity of nasal mucosal lining results in excessive tension on the perforation closure suture line that leads to distal flap ischemia, anastomosis breakdown and, ultimately, reperforation of the septum. Alternatively, using intraoral mucosal flaps of sufficient length and width to close large perforations results in significant and unacceptable donor-site morbidity. We present our technique of harvesting additional local endonasal mucosa using long-term soft-tissue expanders. Long-term nasal mucosal expansion was used in the closure of large septal perforations in five patients. Complications included one case of expander exposure and the morbidity of prefacial expander injections. Total closure of all five septal perforations was documented at the 1-year postsurgical visit. Histologic and electron-microscopic examinations of the expanded nasal floor mucosa are presented.

(Arch Otolaryngol Head Neck Surg. 1995;121:327-331)

Author Affiliations
From the Department of Otolaryngology—Head and Neck Surgery, New York Medical College, Valhalla (Dr Romo); Division of Facial Plastic and Reconstructive Surgery (Dr Romo), Departments of Otolaryngology—Head and Neck Surgery (Drs Jablonski and Shapiro), and Pathology (Dr McCormick), New York (NY) Eye and Ear Infirmary. Dr Jablonski is presently with the Department of Plastic and Reconstructive Surgery, Nassau County Medical Center, East Meadow, NY.

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