The Nasoseptal Chondromucosal Flap: A Rigid Reconstructive Technique for Skull Base and Orbital Defects

Abstract

Introduction: The pedicled mucoperichondrial nasoseptal flap serves as the predominant reconstructive option for anterior skull base defects. Its use has also been described for repair of the lamina papyracea following orbital tumor removal. Large skull base or orbital defects may benefit from a more rigid reconstruction to reduce the risk of herniation of orbital or intracranial contents into the sinonasal cavity, which could result in enophthalmos, diplopia, or an encephalocele. Objective: This study aims to test the feasibility of using a vascularized rigid composite nasoseptal chondromucosal flap for increased structural support in repairing skull base or orbital defects. Methods: The study was conducted in a cadaver model in a surgical skills laboratory. Results: We demonstrate a novel technique for harvesting and insetting a pedicled vascularized autologous rigid composite nasoseptal chondromucosal flap to repair both orbital and anterior skull base defects. The graft is harvested with intact mucosa, cartilage, and bilateral perichondrium to preserve a contiguous vascular supply. Confirmation of successful reconstruction is achieved via transcranial and transorbital access to visualize the graft from above. Conclusion: The cartilaginous support with associated perichondrium adds to the structural integrity of the reconstruction and may serve as an alternative to devascularized autologous grafts or synthetic materials, which may be particularly advantageous in patients with large defects or those requiring adjuvant radiation.