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.

1.
Hadad
G
,
Bassagasteguy
L
,
Carrau
RL
,
Mataza
JC
,
Kassam
A
,
Snyderman
CH
, et al.
A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap
.
Laryngoscope
.
2006
Oct
;
116
(
10
):
1882
6
.
[PubMed]
0023-852X
2.
Turel
MK
,
Chin
CJ
,
Vescan
AD
,
Gentili
F
.
Vascularized nasoseptal flap for medial orbital wall reconstruction
.
J Craniofac Surg
.
2016
Sep
;
27
(
6
):
1532
4
.
[PubMed]
1049-2275
3.
Noel
JE
,
Teo
NW
,
Divi
V
,
Nayak
JV
.
Use of Pedicled Nasoseptal Flap for Pathologic Oroantral Fistula Closure
.
J Oral Maxillofac Surg
.
2016
Apr
;
74
(
4
):
704.e1
6
.
[PubMed]
0278-2391
4.
Chhabra
N
,
Healy
DY
,
Freitag
SK
,
Bleier
BS
.
The nasoseptal flap for reconstruction of the medial and inferior orbit
.
Int Forum Allergy Rhinol
.
2014
Sep
;
4
(
9
):
763
6
.
[PubMed]
2042-6976
5.
Hararah
MK
,
Mattingly
JK
,
Ramakrishnan
VR
.
Use of a contralateral nasoseptal flap for sino-orbital fistula closure
.
J Craniofac Surg
.
2018
May
;
29
(
3
):
709
11
.
[PubMed]
1049-2275
6.
Soudry
E
,
Psaltis
AJ
,
Lee
KH
,
Vaezafshar
R
,
Nayak
JV
,
Hwang
PH
.
Complications associated with the pedicled nasoseptal flap for skull base reconstruction
.
Laryngoscope
.
2015
Jan
;
125
(
1
):
80
5
.
[PubMed]
0023-852X
7.
Westerveld
GJ
,
Middelweerd
RJ
,
Leemans
CR
.
The hinged-door composite septal flap as structural support and lining of nasal reconstruction by a forehead flap
.
Rhinology
.
2001
Mar
;
39
(
1
):
5
8
. [cited 2019 Aug 6] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11340698
[PubMed]
0300-0729
8.
Gadkaree
SK
,
Feng
AL
,
Sharon
JD
,
Richmon
JD
,
Emerick
KS
,
Lin
DT
, et al.
Composite Nasoseptal Flap for Palate Reconstruction
.
J Craniofac Surg
.
2019
Oct
;
30
(
7
):
1990
3
.
[PubMed]
1049-2275
9.
Weisman
RA
.
Septal chondromucosal flap with preservation of septal integrity
.
Laryngoscope
.
1989
Mar
;
99
(
3
):
267
71
.
[PubMed]
0023-852X
10.
Kalyoussef
E
,
Schmidt
RF
,
Liu
JK
,
Eloy
JA
.
Structural pedicled mucochondral-osteal nasoseptal flap: a novel method for orbital floor reconstruction after sinonasal and skull base tumor resection
.
Int Forum Allergy Rhinol
.
2014
Jul
;
4
(
7
):
577
82
.
[PubMed]
2042-6976
11.
Adams
C
,
Ratner
D
.
Composite and free cartilage grafting
.
Dermatol Clin
.
2005
Jan
;
23
(
1
):
129
40
.
[PubMed]
0733-8635
12.
Sinha
UK
,
Johnson
TE
,
Crockett
D
,
Vadapalli
S
,
Gruen
P
.
Three-layer reconstruction for large defects of the anterior skull base
.
Laryngoscope
.
2002
Mar
;
112
(
3
):
424
7
.
[PubMed]
0023-852X
13.
Al-Asousi
F
,
Okpaleke
C
,
Dadgostar
A
,
Javer
A
.
The use of polydioxanone plates for endoscopic skull base repair
.
Am J Rhinol Allergy
.
2017
Mar
;
31
(
2
):
122
6
.
[PubMed]
1945-8924
14.
Durham
SR
,
McComb
JG
,
Levy
ML
.
Correction of large ([{GT}]25 cm(2)) cranial defects with “reinforced” hydroxyapatite cement: technique and complications
.
Neurosurgery
.
2003
Apr
;
52
(
4
):
842
5
.
[PubMed]
0148-396X
15.
Abe
T
,
Goda
M
,
Kamida
T
,
Fujiki
M
,
Kobayashi
H
,
Nakano
T
, et al.
Overlapping free bone graft with galea-pericranium in reconstruction of the anterior skull base to prevent CSF leak and sequestrum formation
.
Acta Neurochir (Wien)
.
2007
Aug
;
149
(
8
):
771
5
.
[PubMed]
0001-6268
16.
Soudry
E
,
Turner
JH
,
Nayak
JV
,
Hwang
PH
.
Endoscopic reconstruction of surgically created skull base defects: a systematic review
.
Otolaryngol Head Neck Surg
.
2014
May
;
150
(
5
):
730
8
.
[PubMed]
0194-5998
17.
Zanation
AM
,
Carrau
RL
,
Snyderman
CH
,
Germanwala
AV
,
Gardner
PA
,
Prevedello
DM
, et al.
Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery
.
Am J Rhinol Allergy
.
2009
Sep-Oct
;
23
(
5
):
518
21
.
[PubMed]
1945-8924
18.
Eloy
JA
,
Choudhry
OJ
,
Christiano
LD
,
Ajibade
DV
,
Liu
JK
.
Double flap technique for reconstruction of anterior skull base defects after craniofacial tumor resection: technical note
.
Int Forum Allergy Rhinol
.
2013
May
;
3
(
5
):
425
30
.
[PubMed]
2042-6976
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.