Costal Cartilage And Costal Perichondrium Sandwich Graft In Septal Perforation Repair

Background: Repair of the septal perforation is a challenging procedure and there are many different surgical techniques. In this study, the authors present a novel method which the authors use costal cartilage and costal perichondrium sandwich graft as an interposition graft with bilateral opposing mucoperichondrial flaps. Patients and Methods: Fourteen patients (5 females, 9 males) underwent septal perforation repair. All surgeries were performed through an open approach septoplasty technique. The edges of the perforation were incised to excise the mucosa with a thickness of 2 mm. Bilateral mucoperichondrial flaps were raised. Then costal cartilage and costal perichondrium were harvested from the rib. The cartilage was divided into a smaller piece which is 2 mm thick and 1 cm wider than perforation size. The prepared cartilage was wrapped with perichondrium to obtain a sandwich graft. This sandwich graft was placed between the mucoperichondrial flaps, corresponding to the perforation. Results: After 9 months of follow-up, 11 (78%) of the 14 perforations were completely closed. Failure of the repair was observed in 3 patients; 2 of the perforations were medium size and one perforation was large size. No complications occurred. Conclusion: Using costal cartilage and costal perichondrium sandwich graft is a novel and useful technique especially in large septal perforations. Considering that septum surgery has an important role in the etiology of septum perforation, this method provides a good graft source for both perforation closure and simultaneous rhinoplasty surgery.