How I Do It: Nasoseptal Flap for Reconstruction of Isolated Soft Palate Defect

A vascularized nasoseptal flap (NSF) provides a novel transnasal option for repairing soft palatal fistulas when traditional transoral flaps have failed or are unavailable, potentially avoiding the morbidity of regional or free tissue transfer. In the current patient who had an 8 × 6 mm soft palatal fistula, the NSF was harvested from the septum and nasal floor, rotated through the nasopharynx to cover the fistula, and was suture-fixated transorally to the mobile soft palate to promote stable adherence and healing. Closure was successful, which resolved her nasal regurgitation, partially improved her velopharyngeal function, and did not cause Eustachian tube dysfunction.