有茎下鼻甲介粘膜弁を用いた鼻中隔穿孔閉鎖術の経験

抄録

Nasal septal perforation can occur from a variety of traumatic, iatrogenic, caustic, or inflammatory causes. Although some cases are asymptomatic, some patients complain of crusting, bleeding, and neuralgia, leading them to seek medical care. We report a patient whose septal perforation was closed using an inferior turbinate mucosal flap and a septal mucosal flap.
A 14-year-old girl that had received epistaxis and electrocautery of the bilateral septal membrane at a hospital experienced pain in her nasal area and a small amount of bleeding a few days later. The patient visited another hospital and was diagnosed as having a nasal septal perforation. She then visited our hospital to have the perforation closed on June 17, 1996. Surgical closure of the septal perforation was performed using an endonasal approach under local anesthesia. A mucosal incision was made in the right nasal cavity along the inferior turbinate edges, leaving the anterior surface intact. The anterior based mucosal flap was then elevated from the inferior turbinate bone. The mucosal flap was swung anteriorly and sutured to the edge of the septal perforation. On the opposite side, the septal mucosal flap was rotated anteriorly to close the perforation. About 6 weeks later, the inferior turbinate mucosal flap was resected. The nasal septal perforation had closed completely, and the patient's nasal complaints have been resolved.
Septal perforation closure is a difficult surgical procedure, and various surgical techniques for closing the perforation have been reported. Septal perforation closures require a well vascularized mucosal flap. We conclude that the inferior turbinate mucosal flap is a useful tissue for closing septal perforations because of its good vascularization.