Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits

Abstract

Background: The nasal floor and inferior meatus (NFIM) flap represents an available option for the reconstruction of a septal perforation (SP). This study explores the feasibility of repairing SPs using a modified simple and extended (including inferior turbi-nate) NFIM flap. Methods: An anatomic study was achieved in fresh frozen cadaveric specimens to measure the area and lengths of NFIM flap. The repair of SP with simple and extended NIFM flaps was performed in some of these cadaveric specimens. Preoperative radiological evaluation of CT scans allowed studying the reconstruction limits of the simple or extended NFIM flap. A cohort of patients with SP who underwent reconstruction with an NFIM flap was also included. Results: Complete SP repair with NFIM was achieved in all specimens (n=10). In 38 fresh cadaveric specimens, coronal (2.6±0.4 cm) and sagittal (4.7±0.6 cm) lengths and area (12.3±2.3 cm2) of simple NFIM flaps were smaller than in extended NFIM flaps (5.7±0.5 cm, 4.7±0.6 cm, 28.8±3.3 cm2 respectively). The radiological analysis of 75 CT scans revealed that 40.2±5.7% and a 79.6±11.1% of septal height could be reconstructed with a simple and extended NFIM flap, respectively. Complete SP repair was achieved in 5 patients (4 male, mean age 57.4 years) using modified NFIM flaps. Conclusion: The simple or expanded NFIM flap represents a feasible option to repair small or medium-sized perforations located at the lower 1/3 or 3/4 of the nasal septum.