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Accepted: 12 October 2017
A new endoscopic technique to close big nasal septal
perforations: Prospective evaluation of the double meat hook
technique in 19 consecutive cases
A nasal septum perforation is a defect in three distinct contiguous
layers, composed of both right and left septal mucoperichondrial
flaps and the intermediate cartilage.
The interruption of the struc-
tural integrity of the septum disrupts lamellar nasal airflow. Subse-
quently, patients can present with a spectrum of complaints such as
nasal obstruction, crusting, recurrent epistaxis, Saddle nose deformi-
ties and whistling.
A septum perforation never closes spontaneously. Management
of symptomatic patients initially has to be conservative with regular
nasal irrigation and emollients.
A silicone septal obturator is an
alternative conservative option but this non-physiological device
can cause irritation and nasal obstruction. When conservative treat-
ment is not helpful, there is a definite indication for surgical treat-
Surgical treatment involves either closure or enlargement of the
perforation. The latter technique is not popular. Surgical repair of big
septum perforations (defined as a diameter of 2 to 4 centimetres) is
a challenging procedure, which is reflected by a modest success
range of 30% to 70% reported in the literature.
Presently, no sin-
gle surgical closure technique is considered a gold standard. The
majority of surgeons prefer a three-layer repair with tension-free
closure of both mucoperichondrial flaps and interposition of an
The technique described in this study is different from existing
techniques to close a big septum perforation. The technique is
endoscopically guided and based exclusively on the use of
extended mucosal flaps from the nose, elevated through a new
type of incision called the double meat hook. The perforation is
closed margin-to-margin and tension-free without the need for dee-
per mucosal incisions as seen in rotation and advancement flaps.
The technique hereby delivers a physiological end result with minor
All patients provided informed consent before commencing treat-
ment, and information was stored in a secure location with anony-
mous evaluation of results.
Between 2010 and 2015, 19 consecutive patients with a big symp-
tomatic septum perforation were treated with the double meat hook
technique by the first author of this study (HD). Patients were fol-
lowed for at least 1 year. The majority of patients were male
(N = 12; 63.2%) with a mean age of 51.5 years (range 26-77).
Causes for the perforations were as follows: cocaine abuse (N = 8;
42.1%), idiopathic (N = 6; 31.6%), post-septum correction (N = 4;
21.0%) and post-traumatic (N = 1; 5.3%) (Table 1).
CORRESPONDENCE: OUR EXPERIENCE