LONG-TERM NASAL MUCOSAL TISSUE EXPANSION USE IN REPAIR OF LARGE NASOSEPTAL PERFORATIONS

Reperforation rates of large, surgically closed nasoseptal perforation s remain unacceptably high (30% to 70%). With the advent of newer surg ical techniques, including external decortication rhinoplasty and midf ace degloving, excellent exposure of the intranasal anatomy is afforde d. The limiting factor of these approaches is the deficiency of local intranasal mucosal lining, which is used to close large septal perfora tions. The paucity of nasal mucosal lining results in excessive tensio n on the perforation closure suture line that leads to distal flap isc hemia, anastomosis breakdown and, ultimately, reperforation of the sep tum. Alternatively, using intraoral mucosal flaps of sufficient length and width to close large perforations results in significant and unac ceptable donor-site morbidity. We present our technique of harvesting additional local endonasal mucosa using long-term soft-tissue expander s. Long-term nasal mucosal expansion was used in the closure oi. large septal perforations in five patients. Complications included one case of expander exposure a nd the morbidity of prefacial expander injecti ons. Total closure of all five septal perforations was documented at t he 1-year postsurgical visit. Histologic and electron-microscopic exam inations of the expanded nasal floor mucosa are presented.