History of and modern uses for the nasoseptal flap in skull base reconstruction after sinonasal malignancy

<h2>Abstract</h2><h3>Objective</h3> The nasoseptal flap (NSF) has revolutionized skull base reconstruction, offering a reliable solution primarily harvested from the nasal septum, with a robust vascular supply that reduces morbidity. Our work provides a comprehensive overview of the evolution, contemporary applications, and promising future of the NSF in addressing the complex challenges associated with sinonasal malignancies. <h3>Methods</h3> Literature review was conducted to study the past, present, and future of the use of NSF for sinonasal malignancies. <h3>Results</h3> The NSF's success hinges on its robust pedicle, supplied by the sphenopalatine artery, and the mucosal and structural anatomy of the nasal septum. It can be tailored to fit various defect sizes and shapes, minimizing donor site morbidity and facilitating rapid healing. Numerous modifications and extensions of the NSF have been developed to cater to various defects, broadening its applications beyond skull base reconstruction. It is increasingly used for postoperative skull base defects, iatrogenic and traumatic skull base defects, and mucosal defects beyond the skull base. Complications of the NSF, including epistaxis, nasal obstruction, and hyposmia, are manageable and minor, but rare complications such as flap necrosis and septal perforation can occur. Current research aims to optimize the use of NSF for treating sinonasal malignancies while also developing methods to effectively study their outcomes. <h3>Conclusions</h3> The NSF's success and ongoing innovations in skull base reconstruction highlight its vital role in addressing sinonasal malignancies and other complex defects in the craniofacial region. Its evolution encourages continued research and collaboration to improve patient outcomes.