The nasal septum: A novel mucosal donor site for fornix reconstruction

Fornix reconstruction in the setting of symblepharon formation conventionally relies on oral mucosa, nasal turbinate mucosa, amniotic membrane, or conjunctival autografts, each bearing distinct limitations such as limited tissue availability, donor site morbidity, inadequate stability, or absence of goblet cells. This report introduces the nasal septum as a novel mucosal donor site that overcomes the inherent shortcomings of traditional graft sources.

A 63-year-old woman with extensive conjunctival cicatrization and symblepharon resulting from toxic epidermal necrolysis underwent fornix reconstruction using nasal septal mucosa as the donor tissue. A 3 × 3 cm mucosal graft was harvested from the posterior dorsal nasal septum under general anesthesia and secured to the reconstructed fornix following adhesiolysis and cicatricial tissue release. Throughout the subsequent 2-year follow-up period, the reconstruction remained stable, with no evidence of recurrent symblepharon or fornix shortening. The incorporated graft demonstrated sustained lubrication and preserved tissue integrity. The nasal donor site healed without complication.

This case establishes nasal septal mucosa as a promising alternative graft tissue for fornix reconstruction, offering distinct advantages over conventional grafts. Its characteristics (presence of goblet cells ensuring adequate lubrication, capacity for large-scale tissue harvest, inherent tensile strength conferring structural stability, and minimal donor site morbidity) make it suitable for complex reconstructive scenarios. The utilization of nasal septal mucosa expands the reconstructive options available to oculoplastic surgeons and warrants prospective evaluation to define its role as a standard technique in fornix reconstruction.