Anatomic study of a nasal septal flap pedicled on the anterior ethmoidal artery for the closure of small anterior nasal septal perforations

Abstract

Abstract Objectives: Define endoscopic landmarks through cadaveric dissection for an optimal harvesting of the septal flap, pedicled on the septal branch of the anterior ethmoidal artery, for surgical closure of small anterior septal perforations. Materials and Method: Twelve nasal cavity dissections were performed on seven human cadavers, after latex injection of the external and internal carotid arteries, respectively in black and red. Twelve mucoperichondrial flaps pedicled on the anterior ethmoidal artery were dissected according to the Castelnuovo method. Macroscopical and microscopical study of the flap’s vascular network were carried out. Results: The origin of the anterior ethmoidal artery’s septal branch was found at 6.75 ± 2.57 mm posterior to the septal projection of the middle turbinate’s anterior insertion. It had a tangential course 3.67 ± 1.03 mm below the skull base. The nasal floor was exclusively vascularized by the external carotid territory. Conclusion: The design of the anterior ethmoidal artery pedicled flap is based on a simple and reproducible technique. We recommend its use for small anterior septal perforations closure. The first septal incision should be vertical, close to the posterior edge of the septal perforation followed by another vertical septal incision starting at least 1 cm posteriorly to the septal projection of the middle turbinate’s anterior insertion and extended to the posterior nasal spine of the palatine bone. The vertical incisions should be at least 5 mm below the skull base. The third incision is horizontal, connecting the two previous incisions, without nasal floor mucosa harvesting.