Endonasal flap reconstruction in sinonasal malignancy

Sinonasal malignancies are a broad, yet rare, class of head and neck cancers with a poor prognosis. Surgical resection is the mainstay of treatment for the majority of tumors. Resection of sinonasal malignancies may result in cerebrospinal fluid (CSF) leak, meningitis, pneumocephalus, and prolonged nasal crusting if not appropriately reconstructed. The advent of endoscopic sinus surgery (ESS) has transformed the field and allowed for fully endonasal resection of sinonasal malignancies. The Hadad-Bassagasteguy flap, now colloquially known as the nasoseptal flap, has revolutionized endonasal reconstruction. The nasoseptal flap is a robust mucoperichondrial flap pedicled on the posterior septal artery, providing a rich and reliable blood supply. The nasoseptal flap has become the workhorse of anterior skull base reconstruction given its relative ease of harvest, reliability, low donor site morbidity and success: CSF leaks rates have decreased from > 20% to < 5% with the use of the nasoseptal flap. This review thoroughly discusses the history, use, and techniques for the nasoseptal flap.