"Practical suggestions on facial plastic surgery--how I do it". Sublabial mucosal flap: repair of septal perforations.

The majority of perforations of the nasal septum, regardless of etiology, create little more than an annoyance to the patient. Perforations commonly may be totally asymptomatic, discovered only on careful nasal examination. It is reasonable to assume, therefore, that only those septal defects creating important symptoms are deserving of repair and correction. Heavy crusting, recalcitrant bleeding and impending or actual loss of dorsal support are justifications for perforation closure. Textbooks and journals abound with suggested varieties of techniques of repair, testifying to the non-effectiveness of any one suitable approach. Local mucosal flaps, turbinate flaps, pedicle skin flaps, and free grafts of skin, dermis, perichondrium, cartilage, and fascia have all been employed with variable results. An inadequate blood supply and unfavorable scarred host bed commonly lead to failure of the above reconstruction methods. In the past five years a horizontal mucosal flap derived from the undersurface of the upper lip has proved reliable and expedient in septal perforation re-epithelialization and closure. The reconstructive procedure is not technically difficult and leads to minimal patient discomfort.