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Original Investigation
Mar/Apr 2017

Use of Costal Perichondrium as an Interpositional Graft for Septal Perforation Closure

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago
  • 2Associate editor, JAMA Facial Plastic Surgery
JAMA Facial Plast Surg. 2017;19(2):121-127. doi:10.1001/jamafacial.2016.1367
Key Points

Question  Is costal perichondrium as an interpositional graft effective in achieving acceptable closure rates of septal perforations?

Findings  In this case series of 51 patients, 44 underwent attempted closure of their septal perforation. The procedure was successful in 42 patients, which indicates a highly successful technique for septal perforation closure.

Meaning  In septal perforations of all sizes, costal perichondrium as an interpositional graft aids in the rate of successful closure of septal perforations.


Importance  Closure of septal perforations remains a technically difficult procedure to perform.

Objective  To assess the use of costal perichondrium as an interpositional graft to enhance closure of septal perforations using bilateral mucosal flaps and the effectiveness of the procedure.

Design, Setting, and Participants  This case series included all 51 consecutive patients presenting with septal perforations from January 1, 2006, to August 31, 2014, at a single institution. Mean (SD) follow-up was 19 (18) months. Patients with subtotal perforations did not have their perforations closed but underwent rhinoplasty with improved form and function. All patients underwent evaluation for changes in postoperative symptoms.

Interventions  Bipedicled mucoperichondrial flaps with placement of costal perichondrium between the repaired flaps.

Main Outcomes and Measures  Success rate of septal perforation closures and the clinical impact of the success of closure as experienced by the patient using the validated Nasal Obstruction Symptom Evaluation (NOSE) questionnaire (range, 0-20; higher scores indicate greater obstruction).

Results  Of the 51 patients (14 male; 37 female; median age, 42.6 [range, 17-69] years), 44 underwent attempted closure of the perforation at the time of the procedure. Closure was successful in 42 of the 44 patients (95%).Two patients had persistent perforations, one of which was subsequently closed in a secondary procedure. Twenty-six of 51 patients with septal perforations completed preoperative and postoperative NOSE questionnaires. The mean (SD) preoperative and postoperative NOSE scores were 12.6 (4.2; range, 6-20) and 3.4 (3.8; range, 0-12), respectively (P < .001). A mean (SD) improvement of 9.0 (3.9) points in the NOSE score was observed from patients after closure of their septal perforation, and 10 patients reported no symptoms (NOSE score, 0).

Conclusions and Relevance  Costal perichondrium is an effective interpositional graft to be used in conjunction with the bilateral mucoperichondrial flaps for closure of septal perforations. Costal perichondrium may be used to aid in closure rates of septal perforations.

Level of Evidence  4.