Raised right-sided nasoseptal flap. The sphenoid crest is exposed all the way down to the sphenoid rostrum. The right sphenoid ostium and the underlying sinus mucosa are identified. The perpendicular plate of the ethmoid forming the posterior third of the nasal septum has been removed to allow for binarial access to the sphenoid sinus. The mucopericondrium on the opposite side is being dissectied in a subperiosteal fashion. The vascular pedicle for the left septum can be preserved and folded down or transected. (Image courtesy of JC Fernandez-Miranda)