Although both revision rhinoplasty and septal perforation repair present a unique set of technical difficulties and challenges, both procedures can be attempted simultaneously by the skilled surgeon using the external or open approach. During surgery, the perforation should be repaired first, and the aesthetic revision should follow, accomplishing as much as possible without compromising the perforation repair. Cases in which the perforation is small and in which a dorsal hump can be reduced are the most appropriate for synchronous correction (Fig. 10A and B, and 11A and B)
Figure 10. A, Preoperative and B, postoperative views of a patient who underwent perforation repair and aesthetic revision.
Figure 11. A, Preoperative and B, postoperative views of a patient who underwent repair of a septal perforation and reduction of a dorsal hump, which provided more mucosa for closure of the defect.
REFERENCES
Fairbanks DNF: Closure of nasal septal perforations. Arch Otolaryngol Head Neck Surg 106:509, 1980
Fairbanks DNF, Chen SCA: Closure of large nasal septal perforations. Arch Otolaryngol Head Neck Surg 91:403, 1970
Goodman WS, Strelzow VV: The surgical closure of nasoseptal perforations. Laryngoscope 92:121, 1982
Kridel RWH: Nasal septal perforation. In Gates G: Current Therapy in Otolaryngology. St. Louis, Mosby Year Book, 1994, pp 361-365
Kridel RWH: The open approach for repair of septal perforation. In Daniel RK (ed): Aesthetic Plastic Surgery: Rhinoplasty. Boston, Little Brown, 1993, p 560
Kridel RWH, Konior Rj: Irradiated cartilage grafts in the nose: A preliminary report. Arch Otolaryngol Head Neck Surg 119:24-31, 1993 Address reprint requests to Russell W. H. Kridel, MD, FACS Facial Plastic Surgery Associates 1200 Binz, Suite 1350 Houston, TX 77004
