Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study

Introduction: The aim of this radio-anatomical study is to ensure that the potential donor area of the pedicled lateral nasal wall flap (PLNW) is adequate to reconstruct nasal perforation. Material and methods: Analysis was conducted on 40 de-identified CT angiographies. The area and length of the PLNW, the septum, and the nasal floor were measured. In a cadaver study, 20 hemi-cranial sagittal sections were also analyzed. The anteriorposterior length of the PLNW flap and the distance between the sphenopalatine foramen and piriform aperture were measured. A clinical study with endoscopic closure of a large perforation was conducted in three patients. Results: The CT angiographies demonstrated an average PLNW area of 10.80 ± 1.13 cm² and a nasal floor area of 3.78 ± 0.58 cm². The septal area (22.54 ± 21.32 cm²) was significantly larger than the total PLNW flap area (14.59 ± 1.21 cm²). The average length of the flap was 5.58 ± 0.39 cm, while the septum was 6.66 ± 0.42 cm; therefore the PLNW flap is insufficient to reconstruct the entire septum. The cadaver study showed that the length of the PLNW flap was 5.28 ± 0.40 cm. These results demonstrate that measurements obtained from CT scans are reliable data and similar to those found in the radiological study. Complete closure was achieved in all three patients. Conclusion: The PLNW flap does not render enough tissue to reconstruct a total septal perforation; however, up to 84% of the septum could be repaired with a PLNW. The potential donor area obtained by CT scan and clinical practice support the approachability of PLNW to repair large septal perforation.