ORIGINAL CONTRIBUTION Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study* Abstract Introduction: The aim of this radio-anatomical study is to ensure that the potential donor area of the pedicled lateral nasal wall fap (PLNW) is adequate to reconstruct nasal perforation. Material and methods: Analysis was conducted on 40 de-identifed CT angiographies. The area and length of the PLNW, the septum, and the nasal foor were measured. In a cadaver study, 20 hemi-cranial sagittal sections were also analyzed. The anterior- posterior length of the PLNW fap and the distance between the sphenopalatine foramen and piriform aperture were measured. A clinical study with endoscopic closure of a large perforation was conducted in three patients. Results: The CT angiographies demonstrated an average PLNW area of 10.80 ± 1.13 cm 2 and a nasal foor area of 3.78 ± 0.58 cm 2 . The septal area (22.54 ± 21.32 cm 2 ) was signifcantly larger than the total PLNW fap area (14.59 ± 1.21 cm 2 ). The average length of the fap was 5.58 ± 0.39 cm, while the septum was 6.66 ± 0.42 cm; therefore the PLNW fap is insufcient to reconstruct the entire septum. The cadaver study showed that the length of the PLNW fap was 5.28 ± 0.40 cm. These results demonstrate that mea- surements obtained from CT scans are reliable data and similar to those found in the radiological study. Complete closure was achieved in all three patients. Conclusion: The PLNW fap does not render enough tissue to reconstruct a total septal perforation; however, up to 84% of the septum could be repaired with a PLNW. The potential donor area obtained by CT scan and clinical practice support the appro- achability of PLNW to repair large septal perforation. Key words: septal closure, pedicle lateral nasal wall fap, septal perforation, septal repair, pedicled nasoseptal fap Isam Alobid 1 , Eric Mason 2 , C. Arturo Solares 2 , Daniel Prevedello 3 , Joaquim Enseñat 4 , Matteo De Notaris 5,6 , Alberto Prats-Galino 5 , Manuel Bernal- Sprekelsen 1 , Ricardo Carrau 7 1 Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain 2 Center for Cranial Base Surgery, Department of Otolaryngology, Georgia Regents University, Augusta, GA, USA 3 Department of Neurosurgery, The Ohio State University Medical Center, Columbus, OH, USA 4 Department of Neurosurgery, Hospital Clinic, Universitat de Barcelona, Spain 5 Laboratory of Surgical Neuroanatomy (LSNA), Hospital Clinic, Universitat de Barcelona, Spain 6 Department of Neuroscience, Division of Neurosurgery, “G. Rummo” Hospital, Benevento, Italy 7 Comprehensive Skull Base Surgery Centre, Department of Otorhinolaryngology, The Ohio State University Medical Center, Colum- bus, OH, USA Rhinology 53: 235-241, 2015 DOI:10.4193/Rhino14.042 *Received for publication: February 10, 2014 Accepted: February 11, 2015 235 Introduction Expanded endonasal approaches (EEA) for the treatment of skull base tumours are rapidly evolving. Good exposure, a complete resection, and the subsequent reconstruction of the resultant defect are paramount requirements for an optimum outcome (1- 3) . In some cases partial or complete septal resection needs to be carried out to achieve an adequate approach or to reconstruct the skull base defect. Subsequently, septal perforation and aesthetic changes may occur in some cases (4) . Other causes of septal perforations include trauma, surgery, infammatory or infections, neoplasms, or abuse of inhaled This paper was orally presented at the 25th congress of the European Rhinologic Society, Amsterdam, the Netherlands 22-26 June 2014.