Abstract
Objective
We describe our experience for repair septal perforation with a septal flap and we analyse the route of the septal branch of the anterior ethmoidal artery (AEA) in the septum area with a radiological anatomy study in order to perform this flap.
Study design
We carry out a prospective analysis with computed tomography scan in the cadaver heads and we perform an endoscopic technique in the patients.
Methods
Ten nasal cavities were analysed in five adult cadaveric heads and two patients diagnosed with anterior septal perforation were surgically treated. Measurements in the cadaveric heads were obtained from a sagittal plane of the nasal septum. The anterior point corresponds to the projection of the anterior insertion of the middle turbinate in the frontal process of the maxilla over the nasal septum. The posterior point was obtained with a vertical line passing through the entrance of the AEA in the nasal septum.
Results
The mean distance between the anterior point and the posterior point was 7.35 mm with a standard deviation of 0.95 mm. The lowest value was 5.5 mm and the highest value was 8.7 mm. We observed good epithelialisation and closure of the perforation in all patients.
Conclusion
The unilateral septal flap pedicle by anterior ethmoidal artery may be used for small and medium perforations with a pedicle smaller than 1 cm posterior to the axilla.
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References
Ayshford CA, Shykhon M, Uppal HS, Wake M (2003) Endoscopic repair of nasal septal perforation with acellular human dermal allograft and an inferior turbinate flap. Clin Otolaryngol Allied Sci 28(1):29–33
Castelnuovo P, Ferreli F, Khodaei I, Palma P (2011) Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 13(6):411–414
Chhabra N, Houser SM (2012) Endonasal repair of septal perforations using a rotational mucosal flap and acellular dermal interposition graft. Int Forum Allergy Rhinol 2(5):392–396
Cogswell LK, Goodacre TE (2000) The management of nasoseptal perforation. Br J Plast Surg 53(2):117–120
Dauber, Wolfgang. Feneis (2007) Nomenclatura anatómica ilutrada/Wolfgang Dauber, 5ª ed. Elsevier, Barcelona, Masson
Dommerby H, Rasmussen OR, Rosborg J (1985) Long-term results of septoplasticoperations. ORL J Otorhinolaryngol Relat Spec 47(3):151–157
Friedman M, Ibrahim H, Ramakrishnan V (2003) Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 113(8):1425–1428
Goh AY, Hussain SS (2007) Different surgical treatments for nasal septal perforation and their outcomes. J Laryngol Otol 121(5):419–426
Gras Cabrerizo JR, Gras-Albert JR, Monjas-Canovas I, Garcia-Garrigos E, Montserrat-Gili JR, Sánchez del Campo F, Kolanczak K, Massegur-Solench H (2014) Pedicle flaps based on the sphenopalatine artery: anatomical and surgical study. Acta Otorrinolaringol Esp 65(4):242–248
Kim SW, Rhee CS (2012) Nasal septal perforation repair: predictive factors and systematic review of the literature. Curr Opin Otolaryngol Head Neck Surg 20(1):58–65
Lee HR, Ahn DB, Park JH, Kim YH, Sin CM, Youn SJ, Kim JS (2008) Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap. Clin Exp Otorhinolaryngol 1(3):154–157
Lindemann J, Rettinger G, Kröger R, Sommer F (2013) Numerical simulation of airflow patterns in nose models with differently localized septal perforations. Laryngoscope 123(9):2085–2089
Monjas-Cánovas I, García-Garrigós E, Arenas-Jiménez JJ, Sánchez-Del Abarca-Olivas J, Campo F, Gras-Albert JR (2011) Radiological anatomy of the ethmoidal arteries: CT cadaver study. Acta Otorrinolaringol Esp 62(5):367–374
Neumann A, Morales-Minovi CA, Schultz-Coulon HJ (2011) Closure of nasal septum perforations by bridge flaps. Acta Otorrinolaringol Esp 62(1):31–39
Oberg D, Akerlund A, Johansson L, Bende M (2003) Prevalence of nasal septal perforation: the Skövde population-based study. Rhinology 41(2):72–75
Park JH, Kim Dw, Jin HR (2013) Nasal septal perforation repair using intranasal rotation and advancement flaps. Am J Rhinol Allergy 27
Pedroza F, Patrocinio LG, Arevalo O (2007) A review of 25-year experience of nasal septal perforation repair. Arch Facial Plast Surg 9(1):12–18
Quinn JG, Bonaparte JP, Kilty SJ (2013) Postoperative management in the prevention of complications after septoplasty: a systematic review. Laryngoscope 123(6):1328–1333
Sarandeses-García A, Sulsenti G, López-Amado M, Martínez-Vidal J (1999) Septal perforations closure utilizing the backwards extraction-reposition technique of the quadrangular cartilage. J Laryngol Otol 113(8):721–724
Thiel W (1992) An arterial substance for subsequent injection during the preservation of the whole corpse. Ann Anat 174(3):197–200
Thiel W (1992) The preservation of the whole corpse with natural color. Ann Anat 174(3):185–195
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Gras-Cabrerizo, J.R., García-Garrigós, E., Ademá-Alcover, J.M. et al. A unilateral septal flap based on the anterior ethmoidal artery (Castelnuovo’s flap): CT cadaver study. Surg Radiol Anat 38, 723–728 (2016). https://doi.org/10.1007/s00276-015-1610-9
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DOI: https://doi.org/10.1007/s00276-015-1610-9