Lateral swing flap of the nasal pyramid: A novel approach to the anterior skull base and review of surgical approaches.

rationaleAnterior skull base lesions in pediatric patients pose distinct surgical challenges owing to ongoing anatomical development and the necessity to preserve facial growth and cosmesis. Traditional approaches may involve significant morbidity or intracranial entry. PATIENT CONCERNS: A 6-year-old boy presented with a several-month history of exophthalmos, lateral displacement of the right eye, and persistent nasal obstruction. DIAGNOSES: Non-contrast computed tomography and magnetic resonance imaging T2-weighted imaging revealed an extradural mass extending into the periorbital region and anterior skull base. Histopathological analysis identified the lesion as an aneurysmal bone cyst.

interventionsWe employed a novel approach utilizing a vascularized nasal pyramid swing flap. The procedure involved en bloc mobilization of the nasal bones, cartilage, and overlying skin, facilitating wide multiaxial exposure of the anterior skull base without intracranial entry. OUTCOMES: Complete resection of the lesion was achieved without cerebrospinal fluid leak or intraoperative complications. Postoperatively, the patient experienced complete resolution of the symptoms with excellent cosmetic results. LESSONS: Our approach demonstrates a tailored, minimally disruptive strategy for benign pediatric skull base lesions requiring extensive extradural access, balancing oncological efficacy with preservation of critical growth centers. Careful patient selection remains essential to avoid malignancies or intracranial involvement necessitating dural repair.