Composite Reverse Septal Flap Following Subtotal Septectomy: A Novel Technique for Re-establishing Tip Support Following Oncologic Resection

Background: Resection of neoplasms involving the septal mucosa often includes removal of the involved mucosa and underlying septal cartilage and/or bone. When located anteriorly in the nasal cavity, this can lead to total loss of tip support with collapse of the lower third of the nose.

Objective: We present a case illustrating subtotal septal resection with preservation of the contralateral septal mucoperiosteum and remaining vomer, which can be utilized for reconstruction.

Technique: A 59-year-old male underwent resection of a nasal cavity squamous cell carcinoma in situ, resulting in total cartilaginous septal resection and partial bony resection with complete loss of structural nasal tip support. The contralateral septal mucoperiosteum remained intact and attached to the residual vomer posteriorly. An osteotomy was designed at the rostrum freeing the remaining vomer from the sphenoid bone, and posterior septal cuts were made to mobilize the composite as an anteriorly based flap. The vomer was then secured in between the medial crural footplates in a tongue-in-groove fashion.

Results: Intraoperatively and in the immediate postoperative setting, he had excellent maintenance of tip support. His final margin status revealed no evidence of tumor or compromise of oncologic resection. He has followed up at the 3-month interval with preserved structural support and no evidence of recurrent disease.

Conclusion: In the appropriately selected patient, the reverse septal composite flap can be considered as an option for reconstruction of the nasal tip support mechanisms following oncologic resection.

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