Simple, but effective: Nasal splinting for airway securement in free flap reconstruction following orbital exenteration

Abstract

Orbital exenteration is a disfiguring procedure that often results in free tissue transfer for reconstructive purposes. The reconstructive focus is the obliteration of dead space while sparing the nasal airway, particularly if the medial orbital wall was resected. Prolapse of transferred tissue into the nasal airway may cause breathing difficulties drastically compromising quality of life. The objective of this study was to demonstrate the effectiveness and feasibility of temporary nasal septum splints as mechanical support for transferred tissue, to prevent airway obstruction. This novel application technique was employed in three patients between 2017 and 2018. No flap loss or sino‐orbital fistulas were observed. On postoperative MRI and endoscopy, a patent nasal airway was observed at all times. Temporary nasal splinting in combination with free tissue transfer proved to be a simple, but effective reconstructive option for securing the nasal airway following orbital exenteration with resection of the medial orbital wall.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…To prevent nasal obstruction associated with free flap reconstruction after orbital exenteration, Rauchenwald et al. performed nasal splinting for 4 weeks after surgery 2107 . Postoperatively, one patient had mild nasal obstruction based on the NOSE questionnaire, and the second patient had moderate nasal obstruction.…”