Naso-conjunctival fistula: a rare variant managed with vascularised galea–pericranium flap

Naso-conjunctival fistula is a rare complication of endoscopic tumour resection. There is a composite deficiency of supporting medial orbital wall and the mucosal linings. A resilient but pliable flap is needed to form the partition, anchor the medial canthus and fill up the orbital volume defect. We present a case of a man in his late 70s having a fistula in the left eye with complaints of air blows during breathing and frequent epiphora for 6 months. He had a lax lower eyelid with clinically evident enophthalmos. The patient was previously operated for locally invasive inverted papilloma. The radiology of the face showed absent medial and inferior orbital walls. The galea-pericranium flap was harvested, tunnelled into the defect and fixed inferiorly to the maxillary periosteum. The fistula got closed and the epiphora improved with no air reflux at subsequent follow-ups. A secondary medial canthal suspension was done at 2 months for a lax lower eyelid.