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Combined Septal Perforation Repair with Revision Rhinoplasty Page 01 Page 02 Page 03 Page 04 Page 05 Page 06 Page 07 Page 08 Page 09 Page 10

Russell W. H. Kridel, MD, FACS

Revision rhinoplasty alone presents enough of a challenge to most surgeons. Similarly, septal perforation closure is such a difficult procedure that many surgeons either avoid attempting the repair or fail in the surgical attempt. If the surgeon is confronted simultaneously with both tasks in the same patient, then he or she will present those patents with a plan calling for two or three operative stages. This article, however, delineates a step-by-step plan via the external approach to both repairs in one surgical setting, which has proved quite successful in cases in which the perforation is 2.5 cm or smaller.

The goal of the surgery is, first, to repair the perforation. The patient is informed that any improvement in appearance is secondary and not to be expected, and it is made clear that a second surgery might be necessary. The external approach to repair the perforation, however, provides the surgeon with the necessary exposure to anatomic structures that he or she might need for the revision rhinoplasty, and, therefore, he or she can tell the patient that the attempt will be made to proceed with the revision rhinoplasty once the perforation is closed. This can occur only when the revision rhinoplasty will not compromise the perforation repair. Nevertheless, combining the two operations is not advisable for the surgeon who is a novice at revision rhinoplasty or septal perforation repair. If the perforation is symptomatic and of such magnitude that it is not advisable to perform a revision rhinoplasty simultaneously, then the first procedure should be the repair of the perforation.

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