Greater palatine artery pedicled flap for nasal septal perforation repair: radiological study and case series

Eur Arch Otorhinolaryngol. 2021 Jun;278(6):2115-2121. doi: 10.1007/s00405-020-06230-1. Epub 2020 Jul 24.


Purpose: The greater palatine artery (GPA) is one of the main vessels supplying the nasal septum. We recently described a novel technique to reconstruct a nasal septal perforation (NSP) using a GPA flap. This radiological study explores the feasibility and limits of using a GPA flap for an anterior NSP repair.

Methods: We describe our technique for repairing anterior-most NSP. Radiological measurements of the GPA flap and their limits were analysed. Additionally, a cohort of four patients who underwent reconstruction of a NSP with a GPA flap was included.

Results: The radiological study of 150 nasal cavities showed a 31.5 ± 2.7 cm2 maximum flap area. Taking into account the retraction process (30%), the remaining area was 22.0 ± 1.9 cm2. The septal area anterior to the GPA was 6.1 ± 2.1 cm2. The septal portion of the flap was larger than the area anterior to the GPA pedicle in all cases. Complete NSP repair was achieved in four patients. All cases of NSP remained closed during the follow-up.

Conclusion: The unilateral GPA pedicled flap is a useful technique suitable for the reconstruction of anterior-most perforations that are difficult to cover with other endonasal techniques.

Keywords: Endoscopic flap; Endoscopic surgery; Greater palatine artery; Septal perforation; Septum reconstruction.

MeSH terms

  • Arteries
  • Endoscopy
  • Humans
  • Nasal Septal Perforation* / diagnostic imaging
  • Nasal Septal Perforation* / surgery
  • Nasal Septum / diagnostic imaging
  • Nasal Septum / surgery
  • Surgical Flaps