4.DISCUSSION
The study findings revealed a successful rate of closure of NSPs with our surgical technique. NSPs can lead to various nasal symptoms. Non-surgical therapeutic options are available for overcoming these symptoms in patients who refuse surgery or who are unsuited, such as nasal washing solutions, moisturizer sprays, and nasal septal button application. However, the only means of entirely and permanently eliminating symptoms is surgery. Several different techniques have been described for surgical repair. Surgical success rates are closely linked to the experience of the surgeon and to the size and site of the NSP. Success rates range between 78% and 93%, depending on the size of the perforation5.
The techniques employed for the repair of NSPs have increased considerably in recent decades. Middle concha and lateral nasal wall posterior pediculated flaps are an appropriate choice for posteriorly located perforations. However, since access to the colummella is difficult, they are not suitable for anteriorly located perforations6. Lower concha flaps can be successfully employed in the closure of large perforations. However, nasal obstructions associated with excess tissue can be observed in this flap technique. In addition, secondary operations for severing the pedicle are required in these flap techniques7. Although nasal floor flaps are an appropriate option for inferior perforations, they are not suitable for superiorly located perforations1. Reperforation rates are lower in operations in which the perforation is closed using bilateral and interposition graft techniques, although the Swell body problem necessitating a second operation may be encountered8. Pericranial flaps are used in the closure of very large perforations. However, morbidity rates are high in this technique, and it is disadvantageous in terms of nasal functions due to the absence of nasal ciliary activity9.
All these surgical techniques have their own advantages and disadvantages. A broad surgical perspective is therefore essential for the repair of NSPs with different characteristics. The closure of NSPs is easier with our technique. The most important advantages of this technique are ease of application and the fact that it does not require secondary operations. The crescent-shaped incision made over the perforation in this technique allows the flap to move freely under the effect of gravity, thus facilitating suturing. Moreover, it allows a larger flap to be obtained in larger perforations by extending the incision in a posterior direction.
The principal disadvantage of our technique is that it cannot be employed in perforations located in close proximity to the nasal roof and that extending to the membranous nasal septum, since it will not be possible to create the flap described.