Endoscopic "crossover flap" technique for nasal septal perforations.

Anasal septal perforation is a defect in any portion of the cartilaginous or bony septum with no overlying mucoperichondrium or mucoperiosteum on either side. In the perforation, the mucosal edges epithelialize, preventing closure of the defect. Although some patients may be completely asymptomatic, symptoms can arise from altered nasal laminar airflow, and they may be severely disturbing to patients. Symptoms tend to be related to the size and location of the perforation. Most symptomatic perforations are large and anterior. Posterior perforations tend to be less symptomatic than others because of humidification from the nasal mucosa and turbinates. Small perforations can cause a whistling sound with inspiration. Other symptoms include crusting, bleeding, nasal discharge, parosmia, and neuralgia. Larger perforations can lead to atrophic rhinitis. Long-standing large perforations may even result in a saddle-nose deformity from a lack of dorsal nasal support. Several techniques for repairing septal perforations have been described over the years, yet no standardized surgical protocol has been established. Repair techniques still present high failure rates and include prosthetic devices, local mucosal flaps, two-stage procedures, and free-flap repair. Currently, nasal flaps are used for numerous purposes, such as choanal atresia (CA) repair, frontal sinus approach, and skull base reconstruction. Now, in this article, we present our endoscopic technique using bilateral mucosal flaps in a crossover interposition for the closure of septal perforations, and its results.