# Trilayer Temporalis Fascia Interposition Graft for Nasal Septal Perforation Repair: A Continued Experience

## TL;DR

A trilayer graft using temporalis fascia and PDS plate effectively repairs nasal septal perforations with high success and symptom improvement.

## Contribution

A trilayer graft technique using temporalis fascia and PDS plate for nasal septal perforation repair is presented with updated clinical outcomes.

## Key findings

- Most patients (78.6%) experienced complete resolution of nasal septal perforation symptoms.
- Only 1.8% of patients had persistent perforation after repair.
- Postoperative complications occurred in 14.3% of patients.

## Abstract

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.

Retrospective chart review.

Single institution.

Retrospective chart review of patients undergoing repair of NSP using a trilayer temporalis fascial interposition grafting technique at our institution from 9/1/2018 to 10/31/2023.

Fifty‐six patients (mean age 45 years, 58.9% female) were included in this study. The suspected cause of NSP was primarily iatrogenic (n = 26, 45.6%); however, a large number of patients did not have a definitive etiology of NSP (n = 18, 32.1%). The most commonly reported symptoms pre‐operatively included nasal obstruction/congestion (n = 51, 91.1%) and nasal crusting (n = 31, 55.4%). NSPs were most frequently anterior in location (n = 46, 82.1%) and medium in size (1‐2 cm) (n = 31, 55.4%), followed by small (<1 cm) (n = 17, 30.4%). All patients within this study experienced improvement in their pre‐existing symptoms associated with NSP, with complete resolution of prior symptoms occurring in the majority of patients (n = 44, 78.6%). A minority of patients in this cohort experienced postoperative complications (n = 8, 14.3%). One patient (1.8%) demonstrated persistent perforation following repair. The median length of follow‐up in this study was 257 days (range 65‐1724).

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