Skull base reconstruction with nasoseptal flap in oncologic cases: can narrow-band imaging help? How we do it

In cases in which the tumour involves the superior septum, careful planning of the flap and clear edges are of paramount importance (Figure 1). Our standard practice is to obtain tissue samples from macroscopically clear areas for frozen sections. This is an essential step to ensure avoidance of tumour seeding at the area of reconstruction. Following narrow-band imaging (NBI) mapping of the septum and nasal cavity, we take a biopsy from the superior edge of the proposed flap (Figure 2) for frozen section. Dual confirmation of the tumour-free edge helps us to proceed with safe reconstruction. The flap is raised following the standard technique, extending to the nasal floor up to the inferior meatus, ensuring Hasner's valve remained intact. On follow-up scans of our cases, there was no evidence of any residual disease related to the flap.