THE ENDONASAL BRIDGE FLAP TECHNIQUE FOR C LOSURE OF SEPTAL PERFORATIONS

A modified surgical method is described for endonasal closure of septa l perforations, using a ''bridge'' flap technique. After extensive ele vation of mucoperichondrium and mucoperiosteum from the entire septum, nasal roof and nasal floor, bipedicle advancement flaps are created. A longitudinal incision is made along the nasal roof on one side above the perforation while a longitudinal incision is made along the later al wall of the lower nasal meatus on the opposite side below the perfo ration. In very large perforations it may be necessary to create two b ridge flaps on each side, one below and the other one above the perfor ation. After bilateral closure of the mucosal defects the cartilaginou s defect is filled with an autogenous cartilage graft taken either fro m the remainder of the septum or from the auricle or rib. A dorsal hum p, saddle deformity or deviation of the nose can be repaired at the sa me time. The method reaches its limits when the vertical diameter of t he perforation measures considerably more than 50% of the height of th e septum. According to our experiences in 82 cases, the success rate o f the method to date can be expected to be about 95%. One patient is r eported as a case example, demonstrating that in event of failure the bridge flap technique is repeatable.