Trilayer Temporalis Fascial Interposition Grafting for Repair of Nasal Septal Perforation

Introduction: The repair of nasal septal perforation (NSP) is complex, with a variety of described techniques and reported outcomes. At our institution, we commonly perform NSP repair using a trilayer graft of thin polydioxanone (PDS) plate wrapped on both sides with temporalis fascia without intranasal flaps. We aim to report our continued experience with this technique.

Methods: A retrospective chart review of patients undergoing repair of NSP using a trilayer temporalis fascial interposition grafting technique at our institution from September 1, 2018 – October 31, 2023 was conducted.

Results: In total, 60 patients (mean age 44.2, 60% female) underwent trilayer temporalis fascial interposition grafting repair of NSP during the study period. The primary cause of NSP was iatrogenic (n = 27, 45%), however a significant number of patients did not have clear etiology of NSP (n = 17, 28.3%). The most common symptoms reported by patients preoperatively included nasal obstruction (n = 55, 91.7%), nasal crusting (n = 35, 58.3%), and whistling when breathing (n = 23, 38.3%). The majority of patients (n = 33, 55%) had undergone prior nasal surgery and had failed trial of nasal steroids (n = 37, 61.7%). When specified, the mean duration of NSP was 33.9 months.

Perforations were most commonly 1-2 cm in size (n = 34, 56.7%) and anterior in location (n = 50, 83.3%). Complete resolution of symptoms following repair occurred in the majority of patients (n = 42, 70%), with only 6 patients reporting development of new nasal symptoms following repair. There were 2 reported postoperative infections which resolved with antibiotics. Only 2 patients demonstrated residual perforation following this technique. Mean follow-up length was 5.9 months.

Conclusions: The trilayer temporalis fascial interposition graft is an effective and reliable tool for the repair of NSP.