Septal Perforation Repair Improves Olfaction and Mucociliary Clearance: A Prospective Study.

OBJECTIVE: Nasal septal perforation (NSP) disrupts normal nasal physiology and may lead to significant functional symptoms. This study aimed to prospectively evaluate changes in olfactory function, nasal mucociliary clearance (MCC), and quality of life (QOL) following septal perforation repair using a fascia lata-costal cartilage sandwich graft (FLCCSG). METHODS: Thirty patients undergoing septal perforation repair via an open rhinoplasty approach with interposition of a FLCCSG were included. Olfactory function was assessed using the Sniffin' Sticks test, MCC using the Andersen saccharin test and QOL using the SNOT-22 questionnaire preoperatively and at 1, 3, and 6 months postoperatively. Functional outcomes were analyzed longitudinally. RESULTS: At the end of the 6-month follow-up, complete closure of the septal perforation was achieved in all patients. A statistically significant improvement in total olfactory scores (TOS) and MCC times was observed at the postoperative 3rd and 6th months compared to the preoperative period (p < 0.001). SNOT-22 scores showed significant improvement at the postoperative 1st, 3rd, and 6th months (p < 0.001). The mean increase in TOS was 7.33 (95% CI: 4.84-9.82), while MCC time decreased by 312.7 s (95% CI: -480.43 to -144.96) and SNOT-22 scores decreased by 18.8 points (95% CI: -24.32 to -13.27). No correlation was found between perforation size and functional outcomes. Smoking was associated with less improvement in olfactory function, while patients with perforations secondary to septal surgery exhibited greater functional recovery. CONCLUSION: Septal perforation repair using a FLCCSG results in significant and progressive improvements in olfactory function, MCC, and QOL beyond anatomical closure alone.