Novel technique for lacrimal duct reconstruction using a tubularized nasomucoperiosteal flap

The medial canthal region is a common site for skin cancers, and its resection often requires a concomitant lacrimal canaliculi resection. Although conventional reconstruction methods, such as dacryocystorhinostomy with placement of a Jones tube, autologous vascular grafting, and conjunctival flaps, have been used, each has notable drawbacks, including restenosis and conjunctivitis. Herein, we report a case of basal cell carcinoma of the lower eyelid in which the lower canaliculus was resected, followed by lacrimal duct reconstruction using a tubularized nasomucoperiosteal flap. A bony window was created from the tumor resection site to the nasal bone. Subsequently, a pedicled nasomucoperiosteal flap was elevated, tubularized, and anastomosed to the lower eyelid conjunctiva, allowing direct drainage of tears into the nasal cavity. At 6 months postoperatively, no complications, such as epiphora or conjunctivitis, were observed. Dacryocystography confirmed satisfactory tear drainage from the conjunctiva into the nasal cavity. This technique enables the reconstruction of a stenosis-resistant lacrimal duct using a pedicled nasomucoperiosteal flap that possesses favorable vascularity, flexibility, and adequate thickness and strength. LAY SUMMARY: This report describes a novel technique for lacrimal duct reconstruction using a tubularized nasomucoperiosteal flap after canalicular resection for basal cell carcinoma. This method creates a durable tear drainage pathway, reducing restenosis and postoperative complications.