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Letters to the Editor
June 2013

Nonopposing Suture Lines in Nasal Septal Perforation Repairs—Reply

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.

JAMA Otolaryngol Head Neck Surg. 2013;139(6):657. doi:10.1001/jamaoto.2013.3384

In reply

We thank Dr Pribitkin for his comments regarding our article “A Novel Technique to Repair Moderate-sized Nasoseptal Perforations.” In response to his remarks about this technique only being a modification of those described by other authors, we must point out that there are differences that make this a useful and novel technique. First, this technique has been performed only via an endonasal or endoscopic approach, sparing the patient an external incision as well as disruption of the soft-tissue envelope of the nose. In contrast, those described in the cited articles by Kridel et al,1 Arnstein and Berke,2 and Ambro et al3 used an external rhinoplasty approach to repair the perforations. Second, the fact that the technique does not include bipedicled flaps bilaterally is a significant difference from the other described techniques, including that described by Fairbanks.4 In addition, although Fairbanks describes nonopposing suture lines, the sutures lines he depicts are overlying the perforation, whereas those in our technique are at the edge of the perforation superiorly or inferiorly, bridged by a cartilaginous interposition graft. Finally, our illustration is meant to show the nonopposing suture lines created by elevating 1 flap that is superiorly based and a contralateral flap that is inferiorly based, as well as to demonstrate the extent of advancement of mucoperichondrium. The flaps are indeed sutured at the edge of the mucoperichondrium as described.

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