Bilateral Bipedicled Advancement Nasoseptal Flaps for Nasal Septal Perforation Repair: Endoscopic Versus Open Rhinoplasty Approach

Objective: To compare open rhinoplasty and endoscopic approaches with bilateral bipedicled advancement nasoseptal flaps in nasal septal perforation repair. Patients and Methods: The current study is a prospective comparative study including 53 patients with symptomatic cartilaginous septal perforation recruited from Otorhinolaryngology department, Menoufia University and distributed as 2 groups. Group I included 25 patients subjected to open approach. Group II included 18 patients subjected to endoscopic approach. Both groups were compared regarding success defined as complete or partial closure, operative details including operative duration and intraoperative blood loss, and postoperative details including patient discomfort, nasal crustations and aesthetic problems. The relationship between the success of each technique and the vertical and anteroposterior diameters of the perforation was assessed. Results: The success rate of open and endoscopic approaches were 80% and 72.2% respectively with no statistically significant difference (p = 0.55). There was a statistically significant relationship between the success of both approaches and the vertical diameter of the perforation (p = 0.001 and 0.002, respectively) There was no statistically significant difference between both groups regarding operative duration and bleeding. (p = 0.73 and 0.52, respectively). There was a statistically significant difference regarding discomfort and aesthetic problems favoring the endoscopic approach (p = 0.004 and 0.04, respectively). Conclusion: Both approaches are successful options for repair of nasal septal perforation with comparable results and operative details. However, the open approach may cause more discomfort and aesthetic problems. The vertical diameter of the perforation is a significant determinant of the success of both approaches.