Septal perforation repair without intraoperative mucosal closure

Objectives/Hypothesis To report a technique for septal perforation repair that does not rely on intraoperative mucosal closure of the perforation defect. Study Design Case series with prospective and retrospective data collection. Methods Nine patients received multilayer interposition grafts and no attempt at intraoperative mucosal closure for repair of septal perforations. Eight patients received multilayer interposition grafts consisting of temporoparietal fascia on one side, polydioxanone plate in the middle, and deep temporal fascia on the other side. One patient received a variant graft consisting of acellular dermal matrix, polydioxanone plate, and full-thickness temporal fascia. Silastic or silicone sheets were placed bilaterally for at least 12 weeks to protect the septum during healing. This technique was applied to a variety of challenging surgical candidates. Results The eight patients who received interposition grafts with bilateral temporal fascia had complete repair of septal perforation sites. The variant interposition graft had complete loss on the acellular dermal matrix side but good integration of temporal fascia on the contralateral side. Conclusions This tension-free technique does not rely on intraoperative mucosal closure of the septal perforation. It has been used to successfully obtain complete repair in a variety of challenging surgical candidates when combined with temporal fascia autografts. Level of Evidence 4. Laryngoscope, 124:1112-1117, 2014