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Page 10 of 13 Bansberg et al. Plast Aesthet Res 2024;11:12 https://dx.doi.org/10.20517/2347-9264.2023.109

Figure 7. Nasal swell body. (A) Swell body is thicker opposite the side of septal deviation. Computed tomography (CT) scan showing
swell body adjacent to perforation’s superior margin; (B) Endoscopic photo of swell body obstructing valve area post repair; (C)
Submucosal elevation with #15 blade to isolate swell body tissue (*); (D) Improved nasal airway following swell body reduction.

Multiple studies have been published on mucosal regeneration and migration procedures for perforation
repair [28-30] . Though different grafts have been used, a construct of superficial temporoparietal fascia (TPF)
wrapped around a thin supportive plate of polydioxanone (PDS) has emerged as the preferred graft [31-33] .
This technique places the responsibility for repair success on regrowth and migration of mucosa over a
tissue scaffold. The rationale for mucosal migration repairs includes technical ease and a decreased risk of
postoperative obstruction compared to mucosal flap procedures.

Recent reviews on septal perforation repair have not found a difference in closure outcomes between
mucosal flap single-layer repairs, multiple-layer repairs, regeneration and migration procedures,
interposition graft application, or surgical approach (endonasal vs. open) [34,35] . Lack of a standardized
approach to perforation assessment and the inconsistent reporting of treatment outcomes were cited in
these reviews. Consensus guidelines on the reporting of perforation measurement and etiology, surgical
complications, a required postoperative time period for study inclusion, and the objective assessment of
symptom outcomes (NOSE-Perf scale) would facilitate the comparative analysis of treatment outcomes.

Aesthetic or functional rhinoplasty performed concurrently with perforation repair increases the surgical
challenge. Multiple factors guide a decision on concurrent surgery, including prior surgical history of
septoplasty, open vs. endonasal septorhinoplasty, perforation characteristics, extent of the aesthetic
deformity, and surgeon preferences for rhinoplasty approach and perforation repair technique. Surgeons
experienced in rhinoplasty and perforation repair have reported high rates of closure and patient aesthetic
satisfaction with concurrent surgery . The open approach provides excellent exposure for the execution of
[2,5]
aesthetic and functional structural maneuvers that may be required for the nose with a perforated septum.
Both surgeon and patient should understand that the perforation repair is prioritized over rhinoplastic
modifications. A disadvantage of the open approach is the weakening of tip support that follows the
separation of the medial crura from the caudal septum. The perforated septum rarely contains enough