2.3 Excision of bony septum and left posterior septal mucosa
Incision is made at the osseocartilaginous junction of the septum,
superior to inferior (Figure 1c). Mucoperichondrial flap is now raised
on the contralateral side extending posteriorly over to the anterior
surface of sphenoid on the contralateral side. Bony septum is removed
using Tilley Henckel forceps or Luc’s forceps until the “keel” is
defined (Figure 2a). At this point, we excise the posterior aspect of
the contralateral mucoperichondrial flap (posterior septotomy) using a
powered microdebrider (Medtronic) (Figure 2b, 2c). The size and position
of this window can be adapted according to tumour features and surgeon
preference, allowing binasal approach to the skull base as standard
practice for endoscopic transnasal approach.