Autogenous mucochondral-osteal nasoseptal graft for reconstruction of orbital floor: a preliminary study

Resection of malignant sinonasal/skull base tumors that erode the orbital floor often result in large defects. We describe a technique for orbital floor reconstruction using a structural pedicled mucochondral-osteal nasoseptal flap (PMCONSF) that includes both soft tissue and bony-cartilaginous components with a continuous pedicled vascular supply. Case presentation was 11 patients having tumors associated with midface requiring maxillectomy and removal of inferior wall of orbit were included. Reconstruction of floor of orbit was done using PMCONSF. Post-operative outcomes of the techniques were studied. In all 11 cases reconstruction of floor of orbit was done using pedicled nasoseptal cartilage and in none of the cases communication of the orbital content with maxillary sinus was encountered. Complete ophthalmic examination revealed no significant diplopia, no entrapment of ocular structures with good ocular motility. Adequate reconstruction of the orbital floor is crucial to maintaining long-term ocular function. The PMCONSF offers great flexibility in flap design as well as a high rate of success. The bony-cartilaginous component offers a rigid structural part to the orbital floor, eliminating the functional defects that can occur from anatomical changes. The pedicled vascular supply helps assist in graft integration, limiting the potential for graft rejection or necrosis following postoperative radiotherapy. We believe that this graft offers a viable alternative to existing methods for orbital reconstruction in patients with large orbital floor defects, especially for cases in which adjuvant postoperative radiotherapy is anticipated.