2026 Proffered Presentations
S291: A NOVEL RECONSTRUCTIVE TECHNIQUE FOR NASAL LINING IN PARTIAL RHINECTOMY DEFECTS UTILIZING THE ANTERIOR ETHMOID ARTERY PEDICLED ROTATIONAL FLAP
Kelly E Daniels, MD; Eric W Wang, MD; UPMC
Background: Partial rhinectomy defects present a reconstructive challenge, due to the involvement of multiple aesthetic subunits and multi-layered nature of the nose and sinonasal cavity, including its lining consisting of ciliated pseudostratified columnar respiratory epithelium. Historically, free tissue transfer or nasal prosthesis are most commonly used for rhinectomy defects. The anterior ethmoid artery flap provides a unique source of vascularized mucosa and has been described for small anterior septal perforations, but it has not been utilized in the instance of complex multilayer reconstruction as necessitated in cases of malignancy.
Objective: We aim to present a novel low-morbidity technique for reconstruction of multilayer nasal defects utilizing a vascularized pedicled local flap based on the anterior ethmoid artery. We present indications for its implementation, a detailed description and visual guide to the surgical technique, as well as challenges and pearls.
Methods: This case series presents three patients who underwent partial rhinectomies for primary treatment of squamous cell carcinoma involving the anterior septum and lower lateral cartilages and whose reconstruction included the use of the vascularized anterior ethmoid artery flap.
Technique: For each patient, the ablative portion of the surgery was completed first via a combined open and endoscopic septorhinoplasty approach and intraoperative frozen pathology was utilized to confirm negative margins. Once negative margins were achieved, reconstruction of the nasal lining was initiated utilizing unilateral or bilateral anterior ethmoid artery flaps. Based on the patient’s individual defect, the elevated anterior ethmoid artery flap was either rotated medially to provide coverage over the anterior septum and newly reconstructed L-strut of the dorsal and caudal septum or laterally to cover the lateral crus and lateral construct. This vascularized flap was used in combination with cartilage carving techniques and / or paramedian forehead flaps for cartilaginous and cutaneous reconstruction, respectively. The open septorhinoplasty approach allows for direct suture control of the epithelium.
Results: All patients underwent uncomplicated surgeries and were discharged on post-op day 1. All patients were recommended adjuvant treatment for high risk features, two of which agreed to and completed. Two of three patients had excellent flap take which was sustained after completing adjuvant radiation or concurrent chemotherapy and radiation . One patient with partial flap loss had comorbid type two diabetes and was unable to achieve smoking cessation, with active daily smoking in the perioperative period and at subsequent follow-up appointments.
Conclusions: The pedicled anterior ethmoid artery flap is an effective novel technique for addressing the loss of internal nasal lining during ablative septectomies and rhinectomies. This is especially advantageous over free mucosal grafts in patients who are anticipated to require adjuvant radiation and who undergo significant cartilaginous reconstruction. As with all reconstructive surgery, smoking cessation is of utmost importance and failure to do so may result in compromise of the reconstruction.