2023 Volume 62 Issue 2 Pages 322-331
It is now widely recognized in Japan that nasal valve obstruction is a cause of symptoms of nasal obstruction. Perforation of the nasal septum can also cause these symptoms and is sometimes treated surgically. We report a case of nasal obstruction with internal nasal valve obstruction and nasal septal perforation, in which nasal septal perforation repair and open septorhinoplasty were performed simultaneously with excellent results. The patient was a 61-year-old male who had undergone nasal septal surgery 30 years previously. He had a history of nasal obstruction symptoms that had worsened over the past several years and he was referred to our department for initial consultation, after visiting an otorhinolaryngology clinic. The patient was found to have a leftward slanting nose, depression of both nasal valves on inhalation, nasal septal perforation of 13 × 8 mm in the anterior nasal septum, and leftward nasal septum deviation with a spur. Simultaneous surgery was performed for external open septorhinoplasty and nasal septal perforation repair. Bilateral marginal incisions joined to an “inverted-v” transcolumellar incision were made to expose the lower lateral cartilage, the upper lateral cartilage, and the nasal septal cartilage. The nasal septal mucosa in the upper part of the perforation was dissected up to the medial aspect of the upper lateral cartilage, while in the lower part, the nasal mucosa was dissected from the bottom of the nasal cavity to the inferior nasal meatus. A U-shaped incision was made in the mucosa of the nasal floor to advance the upper and lower mucosal flaps and suture the perforation. In addition, the right temporal fascia and auricular cartilage were harvested and used as a connective tissue graft for the nasal septal perforation and a spreader graft for the nasal valve obstruction, respectively. Postoperatively, the nasal septal perforation was closed and the symptoms of nasal obstruction disappeared. In recent years, various endoscopic septal perforation repair techniques have been developed; however, our case suggests that simultaneous nasal septal perforation repair and open septorhinoplasty should be considered in patients with nasal obstruction with combined nasal valve obstruction and nasal septal perforation, or with suspected fragility of the external nose.
