Endoscopic repair of large septal perforations with tipped mucosal flaps in 28 cases Abstract: Purpose: There are many methods to repair septal perforations, but the success of repairing perforations larger than 1 cm in diameter is still less certain. The purpose of this article is to introduce the methods of repairing large septal perforations using nasal septal tipped mucosal flaps, nasal septal cartilage or bone-tipped mucosal flaps and inferior turbinate and nasal floor tipped mucosal flaps respectively under nasal endoscopy, and to compare the results and advantages and disadvantages of each method. DATA AND METHODS: A total of 28 cases of repair of large septal perforations (>1 cm and <2 cm in diameter) were completed from January 2004 to February 2008. Eight cases of perforation repair were performed with septal tipped mucosal flaps, 16 cases with septal cartilage or bone-tipped mucosal flaps, and 4 cases with tipped mucosal flaps in the inferior turbinate and nasal floor. The nasal septum-tipped mucosal flap refers to repairing the perforation by simply using one side or both sides of the septal perforation with a transferred mucosal flap; the nasal septum cartilage or bone-tipped mucosal flap refers to repairing the perforation by using a transferred mucosal flap with cartilage or bone on one side of the nasal septum perforation, or by using a transferred mucosal flap and a free piece of cartilage or bone to repair the perforation; the inferior turbinate and nasal floor with a tipped mucosal The mucosal flap of the inferior turbinate and nasal floor was turned to the opposite side, and the mucosal flap of the septal perforation edge on the opposite side and the anterior side was turned to the other side, so that the traumatic surfaces of the two tipped mucosal flaps were closed to each other to repair the perforation. All cases were followed up from 2 months to 4 years after surgery, with a mean follow-up of 22 months, and nasal endoscopy was used to determine the effect of perforation repair (cure = complete repair of perforation seen under nasal endoscopy; effective = partial repair of perforation seen under nasal endoscopy; ineffective = perforation not repaired under nasal endoscopy or even enlarged compared with preoperative = failure). The efficacy of the various surgical approaches was summarized, and their advantages and disadvantages were evaluated. Results: 62.5% (5/8) of the nasal septum with tipped mucosal flap group was cured, 12.5% (1/8) was effective, and 25% (2/8) was ineffective; 100% (16/16) of the nasal septum cartilage or bone-tipped mucosal flap group was cured; 50% (2/4) of the inferior turbinate and nasal floor with tipped mucosal flap was cured, and 50% (2/4) was ineffective. In the inferior turbinate and nasal floor mucosal flap group, there was one case with postoperative lacrimal obstruction, but no significant complications occurred in other cases. Conclusion: The use of cartilaginous or bone-tipped mucosal flaps has a higher success rate than the use of tipped mucosal flaps alone to repair large septal perforations, and this method should be used as much as possible when the mucosal conditions around the septal perforation allow. When sufficient mucosal flaps cannot be obtained around the perforation, the use of tipped mucosal flaps of the inferior turbinate and nasal floor can be considered. For cases larger than 2 cm in diameter and with atrophy and thinning of the nasal mucosa, all of the above methods are difficult to repair successfully. Keywords: nasal septal perforation; endoscopy.