The Le Fort I maxillary osteotomy approach to nasal septum perforation repair : authors’ experience

The goal of nasal septal perforation repair is to restore the normal physiology of the nose. The surgical approaches described in the literature include closed (intranasal access, possibly using nasal endoscopy), open (open rhinoseptoplasty and enlarged version), and degloving approaches. The Le Fort I osteotomy, widely used as an approach for skull base tumour removal, has not been described as an access for closing a septum perforation surgically. The authors found that this approach provides an excellent surgical exposure and a low incidence of complications; this surgical technique is quick and easy if performed by a team with experience in orthognathic surgery. This article describes the use of the Le Fort I maxillary osteotomy as an access for nasal septum reconstruction in the treatment of two patients at the Department of Maxillofacial Surgery of the Istituto Ortopedico Galeazzi in Milan (Italy). The septal defects had diameters of 7 and 16 mm. The septal perforation repair included harvesting a single-pedicle mucoperiosteal flap derived from the nasal floor without autogenous or heterologous tissue interposition. Nasal endoscopy showed complete healing in one patient and 75% closure in the other. Both maintained their preoperative dental occlusion and neither has developed a nasal synechia. The discomfort, expressed on a VAS scale from 0 to 10, was reduced from 10 to 3 in one patient and from 7 to 0 in the other. The follow-up was for 9 months.