Minimally Invasive Endoscopy-Assisted Approach for En Bloc Resection of Septal Tumors

Background: Open approaches to the nasal septum include lateral rhinotomy for anterior tumors, and midface degloving, which affords better exposure of the entire osseocartilagenous framework, for posterior and dorsal tumors. Endoscopy affords excellent visualization with minimal morbidity and avoidance of an external scar but has only been used for limited anterior lesions.

Case Report: We present the case of a 65-year-old woman with a large high grade mucoepidermoid carcinoma involving the septum, with significant posterior and dorsal extension. Complete en bloc resection of the 4-cm lesion was achieved with a novel approach combining endoscopy with alotomy and open rhinoplasty dissection. The patient had an excellent cosmetic outcome, with minimal scarring and preserved tip support.

Discussion: The technique we describe allowed for the resection of a 4-cm lesion, largely confined to the nasal septum but with extensive posterior and dorsal extension. The approach provides the posterior access of a midface degloving without the unnecessary maxillary exposure and dissection, combined with the dorsal septal exposure of an open rhinoplasty, all with the improved visualization of endoscopy. The incisions are less conspicuous than standard lateral rhinotomy and heal with minimal scarring. The approach is straightforward to perform, provides direct access to the entire osseocartilaginous septum, and is less invasive than the other open alternatives. With minimal added morbidity this approach should be considered for septal tumors extending too far dorsally or posteriorly to be accessed by lateral rhinotomy alone.