IMPROVED UNILATERAL MIDDLE TURBINATE MUCOSAL FLAP TECHNIQUE FOR THE REPAIR OF NASAL SEPTAL PERFORATION: A SANDWICH RECONSTRUCTİON BY A COMBINED USE OF UNILATERAL MIDDLE TURBINATE FLAP AND FREE İNFERIOR TURBINATE GRAFT.

Objectives: We aimed to present our experience with the improved version of previously reported unilateral middle turbinate mucosal flap technique by addition of a free graft from inferior turbinate for the repair of nasal septal perforation. Methods: This was a retrospective series of 30 patients aged 24-45 (19 women, 11 men) who were operated for the reconstruction of nasal septal perforation between 2010 and 2015. Patients were evaluated clinically by anemnesis, detailed nasal examination and endoscopy. Twenty-two patients had large perforation (2-3 cm), while 8 had perforation <2 cm in size. Sixteen patient were active cigarette smokers. The septal perforation was repaired surgically by a sandwich reconstruction technique, which includes the covering of one side of perforation by a bone containing conchal flab obtained from middle turbinate and the other side by a graft obtained from free inferior turbinate. Results: The patients were followed up postoperatively for 20 months (18-24 months range). The nasal septal perforation was completely closed in 29 out of 30 patients, providing a success rate of 96.7%. In only one patient who was actively smoking, the repair was failed. Conclusion: Bilateral sandwich reconstruction, which is the the combined use of middle turbinate flap and free inferior turbinate graft should be considered as an alternative repair technique for large nasal septal perforations.