A Novel Approach to Medial Orbital Wall Reconstruction After Orbital Exenteration Using the Nasal Superficial Musculoaponeurotic System Flap: A Case Report

We describe a novel application of the nasal Superficial Musculoaponeurotic System flap for medial orbital wall reconstruction following orbital exenteration. A 64-year-old woman underwent type IIa exenteration for moderately differentiated squamous cell carcinoma of the right medial canthus, requiring resection of the lamina papyracea. A pedicled nasal Superficial Musculoaponeurotic System flap incorporating perichondrium and based on the dorsal nasal artery was harvested through a midline nasal incision to close a 1.5-cm communication between the orbit and nasal cavity. To provide additional stability and coverage, a contralateral supratrochlear artery-based paramedian forehead flap was employed. Postoperative evaluation confirmed flap viability and satisfactory anatomical separation between the orbit and nasal cavity. To our knowledge, this is the first reported use of a nasal Superficial Musculoaponeurotic System flap in orbital reconstruction. This case highlights its potential as a reliable and well-vascularized option for selected medial orbital wall defects.