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Bansberg et al. Plast Aesthet Res 2024;11:12 https://dx.doi.org/10.20517/2347-9264.2023.109 Page 5 of 13

Table 2. Surgical failures by surgical versus non-surgical etiology
Surgical etiology
Case Age (yrs) Etiology Perforation size Postoperative time to Failure size (mm) / Disposition at last follow-up
/sex (m/f) length × width failure (months) Septal position
(mm) (anterior vs. mid)
1 40/F Surgery 16 × 16 2 3/mid Asymptomatic
2 Surgery 16 × 10 4 5/ant Successful second flap closure
51/F attempt
3 41/M Surgery 12 × 10 2 3/mid Decreased symptoms
4 56/F Surgery 13 × 8 8 4/mid Decreased symptoms
5 28/F Surgery 8 × 7 2 5/ant Failed second flap closure
attempt, symptomatic
6 17/M Surgery 5 × 4 3 5/ant Successful second flap closure
attempt
7 57/F Surgery 15 × 7 4 3/mid Asymptomatic
8 76/F Surgery 16 × 12 5 14/ant Symptom improvement
following posterior septal
resection
9 32/M Surgery 22 × 10 6 8/mid Asymptomatic, revision
rhinoplasty 4 years postop
Non-surgical etiology
10 60/M Indeterminant 26 × 24 3 2/mid Asymptomatic
11 58/F Indeterminant 32 × 21 4 8/mid Symptomatic, on conservative
treatment
12 24/F Cautery 28 × 19 10 Symptomatic revision valve
surgery performed 6 months
postop
13 58/F Cocaine 22 × 18 4 4/mid Minimal symptoms
14 52/M Decongestant 20 × 18 6 20/ant Symptomatic posterior
spray resection offered
15 39/F Granulomatous 18 × 18 4 4/ant Minimal symptoms.
polyangiitis Rhinoplasty performed 13
months postop
16 69/M Cauterization 17 × 14 2 3/ant Deceased 4 months
postoperative
17 57/M Indeterminant 15 × 11 2 4/mid Symptomatic
18 47/F Steroid nasal spray 12 × 10 6 5/ant Symptomatic
19 19/M Indeterminant 12 × 8 5 4/ant Minimal symptoms, offered
second closure attempt
20 22/F Digital trauma 12 × 10 2 4/ant Successful second flap closure
attempt

Eight patients did not have interposition grafts placed at the time of surgery and one of those repairs failed.
All patients in this no-graft cohort underwent prior septal surgery.

DISCUSSION
Though caudal end deformities frequently pose the greatest technical challenge to success in septoplasty and
functional septorhinoplasty, it is the integrity of the mucosal elevation posterior to the caudal end that
determines the risk for perforation. Wide bilateral elevation in the submucoperichondrial/periosteal plane
prior to the mobilization and removal of cartilage/bone prevents the tearing or avulsion of mucosa.
Intraoperative bleeding is minimized, and surgical visualization maximized, when meticulous dissection is
performed in the proper subperichondrial plane. The thin mucosa overlying septal deviations and spurs can
be difficult to elevate intact. Mucosal tunnel elevation inferior to the spur with subsequent fracturing of the
bone to the opposite side improves the ability to separate mucosa intact from the spur. Endoscopic