Structural pedicled mucochondral‐osteal nasoseptal flap: a novel method for orbital floor reconstruction after sinonasal and skull base tumor resection

Abstract

Unrepaired orbital floor defects after sinonasal and skull-base tumor resection can lead to herniation of orbital contents into the maxillary or ethmoidal sinuses, possibly resulting in infection and significant cosmetic and functional deficits. Orbital floor defects are usually repaired using prosthetic implants or autogenous material. Nasal septal cartilage has been used previously as a free graft for reconstruction. However, its reliance on local vascular supply can result in ischemia and necrosis in the postoperative period. The vascularized pedicled nasoseptal flap, consisting of mucoperichondrium and mucoperiosteum, is routinely used as an effective reconstruction method for endoscopic repair of cerebrospinal fluid leaks arising from skull base dural defects. However, this flap does not provide rigid structural reconstruction when used alone. We report a case of an orbital floor defect repaired using a pedicled mucochondral-osteal nasoseptal flap. This technique incorporates the structural component of the nasal septal cartilage and bone with the vascularized pedicled nasoseptal flap. This repair technique may be useful in patients requiring postoperative radiotherapy.