الفهرس 
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Abstract
Septal perforations are difficult problems that the otolaryngologist has to solve. The majority of symptomatic NSPs require surgery, but there is no standard surgical approach in NSP closure, which still remains a surgical challenge. All surgical procedures, aimed at repair of nasal septal perforations, are based on two main principles, namely repair using mucosal, mucoperichondrial, and/or mucoperiosteal flaps with or without interposition of a graft material between mucosal flaps.
Surgical repair of septal perforation can be carried out using either the “closed technique” or “open technique”. The advantage of the former is that it does not leave any external scar. However, drawbacks related to difficulties due to the narrow operating field may be encountered. Many surgeons prefer the “open” technique, as it offers a wider operating field, thus allowing better access to the superior and posterior margins of the perforation (especially in large and/or posterior perforations), and offering binocular vision.
The aim of this study is to compare an open approach using bilateral bipedicled advancement flaps with and interposition cartilage graft and an endoscopic approach using a novel reverse flap technique regarding success of closure, operative details and postoperative improvement of nasal symptoms. Also we aimed to determine the relationship between the vertical and anteroposterior diameters and success of each procedure.
The current study included 34 patients with symptomatic anterior septal perforation with idiopathic or iatrogenic etiology and no associated pathology. The patients were recruited from the outpatient clinic of Otolaryngology Department, Menoufia University and other private centers in Menoufia Governorate during the period from July 2015 to July 2017. All patients of the study were subjected to routine preoperative assessment including history taking, anterior rhinoscopy, endoscopic examination and Computed Tomography. Seven preoperative symptoms including crustations, epistaxis, discharge, pain, obstruction, whistling and overall discomfort were assessed using Visual Analog Scale (VAS). The size of the perforation was assessed with measuring of the vertical and anteroposterior diameters of the perforation.
Patients of the study were distributed into two groups according to the decision of the surgeon. group I included 20 patients who were subjected to open rhinoplasty approach with bipedicled advancement flap technique with interposition of conchal cartilage graft. group II included 14 patients who were subjected to endoscopic reverse Hadad flap technique. The operative details for each technique were measured including operative duration and intraoperative blood loss.
Postoperative success of closure of the perforation was assessed. Postoperative symptom scores were assessed for both techniques and compared with preoperative scores. The degree of improvement of symptom scores was compared between the two techniques. The relationship between the success of each procedure and the anteroposterior and vertical diameter of the perforation was assessed.
At the end of the study, we found that both open rhinoplasty approach with bipedicled advancement flaps and reverse Hadad techniques are effective methods for repair of nasal septal perforation with no significant difference between the two techniques regarding the success rates (85 % and 71.4% respectively). Both techniques were followed by a highly significant improvement of all preoperative symptoms. However the degree of improvement of crustations is better in open rhinoplasty.