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.