Multiple surgical methods for perforation closure have been described, with the most successful outcomes reported in cases in which sliding, bilateral intranasal mucosal flaps are advanced and a connective tissue autograft is transposed between the sutured mucosal flaps.
Fairbanks has advocated this method by way of a highly successful closed intranasal approach, which, at times, is aided by lateral alar crease incisions for exposure.1,2 Strelzow and Goodman3 and Kridel and associates5 described the open, external approach for this method, which is suited particularly for simultaneous revision rhinoplasty because the approach is the same and avoids the difficulty of having to work inside a nose that may have been made more narrow by alar base excisions. The external approach also avoids a hemi-or full-transfixion incision, preserving the anterior columellar blood and lymphatic supply to the mucoperichondrial septal flaps, which must be repaired. The well-closed trans columellar incision is less noticeable than most alar crease scars.
The larger the perforation is in its vertical height, the more difficult the repair will be. Perforations of 1.5 cm or smaller can usually be closed, and success rates of over 90% can be achieved in most perforations of 2.5 cm or smaller.
