Vascularized middle turbinate mucoperiosteal flap in skull base defects: follow-up analysis of 20 cases (original) (raw)
Related papers
Turkish Archives of Otorhinolaryngology, 2021
Objective: Middle turbinate (MT) flap, based on the branches of sphenopalatine artery is one of the commonest mucosal flaps used in endoscopic skull base surgery. The objective of this study is to analyze the outcomes of the MT flap in the reconstruction of non-tumorous ventral skull base defects. Methods: A retrospective review of patients was done from 2010-19. Patients who underwent reconstruction for non-tumorous ventral skull base defects using middle turbinate (MT) flap were included in the study. The parameters assessed include patient demography, primary etiology, site of the defect, size of the defect, graft materials used, outcomes and postoperative complications. Results: A total of 13 patients who met the study criteria were included. Three (23.07%) of the patients had meningo-encephalocele, while the remaining 10 (76.93%) had CSF fistula. Isolated foveal defect (53.8%) was the most common site involved, followed by isolated cribriform, combined cribriform-foveal and combined foveal-planar defects. Graft materials used were fascia lata, fat and septal cartilage. MT flap was successfully harvested in 11 (84.6%) patients, with successful outcome in 10/11 patients. Hypoplastic MT was present in two patients, who subsequently required Hadad flap for defect closure. No major complications were reported in the postoperative period. Conclusion: The MT flap is effective in the reconstruction of selective skull base defects. Appropriate surgical technique and expertise are required for successful harvest. Further studies are required to analyze its outcomes in various skull base defects.
Extended inferior turbinate flap for endoscopic reconstruction of skull base defects
Journal of neurological surgery. Part B, Skull base, 2014
Objective When the use of the nasoseptal flap for endoscopic skull base reconstruction has been precluded, the posterior pedicle inferior turbinate flap is a viable option for small midclival defects. Limitations of the inferior turbinate flap include its small surface area and limited arc of rotation. We describe a novel extended inferior turbinate flap that expands the reconstructive applications of this flap. Design Cadaveric anatomical study. Participants Cadaveric specimens. Main Outcome Measures Flap size, arc of rotation, and reconstructive applications were assessed. Results The average width of the flap was 5.46 ± 0.58 cm (7.32 ± 0.59 cm with septal mucosa). The average length of the flap was 5.01 ± 0.58 cm (5.28 ± 0.37 cm with septal mucosa). The average surface area of the flap was ∼ 27.26 ± 3.65 cm(2) (40.53 ± 6.45 cm(2) with septal mucosa). The extended inferior turbinate flap was sufficient to cover clival defects extending between the paraclival internal carotid arter...
The inferior turbinate flap in skull base reconstruction
Journal of Otolaryngology - Head and Neck Surgery, 2013
Background: As the indications for expanded endonasal approaches continue to evolve, alternative reconstructive techniques are needed to address increasingly complex surgical skull base defects. In the absence of the nasoseptal flap, we describe our experience with the posterior pedicle inferior turbinate flap (PPITF) in skull base reconstruction. Design: Case series.
Inferior turbinate pedicle flap for endoscopic skull base defect repair
American Journal of Rhinology & Allergy, 2009
Background: Endoscopic skull base reconstruction (ESBR) is an important advance in the management of skull base defects. Large dural defects usually require the use of pedicled mucosal flaps for successful repair and prevention of cerebral spinal fluid leak. Planning for pedicled flaps is important because raising the flap is often required before tumor removal or initial surgical access. The potential utility of the inferior turbinate pedicled flap (ITPF) in ESBR is assessed.
Anteriorly Based Inferior Turbinate Flap for Endoscopic Skull Base Reconstruction
Otolaryngology–Head and Neck Surgery, 2012
ObjectiveIn the absence of the nasal septal flap, there is limited ability to reconstruct the anterior skull base because of the paucity of alternative intranasal vascularized flaps. In this article, the authors describe the anteriorly pedicled inferior turbinate flap (AITF) as a method for endoscopic reconstruction of anterior skull base defects.Study DesignA case series with chart review of the demographic, clinical, surgical, and early follow‐up data of patients who underwent endoscopic reconstruction of skull base defects by the AITF.SettingAn academic cancer center.MethodsThe nature of the arterial blood supply of the inferior turbinate from the anterior ethmoidal artery was exploited to design an anteriorly pedicled flap. Flap survival, adequacy of the seal, and rate of complications were assessed.ResultsSeven patients were suitable to undergo anterior skull base reconstruction using the AITF with or without combinations with other flaps. Each had a high‐flow intraoperative ce...
Modified Posterior Pedicle Middle Turbinate Flap: An Additional Option for Skull Base Resurfacing
The Laryngoscope
Objectives/HypothesisAlthough the Hadad‐Bassagusteguy flap represents the first choice for middle and posterior skull base reconstruction and coverage of exposed bony areas, in some cases it is unavailable. The aim of this study is to describe, as an alternative option in selected cases, a modified posterior pedicle middle turbinate flap (mPPMTF) extended to the lacrimal area. Anatomical features, step‐by‐step harvesting technique, and surgical applications are presented.Study designAnatomic dissection study and case report.MethodsFour mPPMTFs were raised in two fresh‐frozen cadaver heads. A study of the vascular supply and measurements of length, width, and area of the flap were performed. The ability of the flap to cover the ventral skull base, particularly the upper clivus area, was tested. A clinical case in which an mPPMTF was used for clivus resurfacing after osteoradionecrosis is reported.ResultsThe vascular supply of the mPPMTF was identified as the middle turbinate branch o...
Journal of Otolaryngology Research, 2018
Introduction: To study the clinical outcomes of posterior nasal septal flap in endonasal reconstruction of anterior skull base defects. In the patients with large dural defects of anterior and ventral skull base, there is a significant risk of post-operative cerebrospinal fluid (CSF) leak. Advances in surgical technique, instrumentation, and intraoperative image guidance have made reconstruction of even large dural defects possible. Reconstruction with the vascularised tissue is desirable to facilitate rapid healing, especially in irradiated patients. Hadad-Bassagasteguy flap (HBF), a vascular pedicled flap of the nasal septum mucoperiosteum and mucopericondrium based on the posterior septal artery (branch of sphenopalatine artery), was first developed in university of Rosario, Argentina, for reconstruction of ventral skull base dural defects [1]. It is increasingly becoming a “workhorse” for the reconstruction in extended endonasal skull base surgery. Endoscopic endonasal repair of traumatic CSF leaks with the posterior nasoseptal flap (PNSF) has a success rate of approximately 95% comparable to that of traditional approaches [1]. Fortes et al used the Hadad–Bassagasteguy flap and reported a 5% incidence of CSF leak, which is similar to the rate after open craniotomy [2]. A posterior nasoseptal flap preserves the possibility of raising a Hadad–Bassagaisteguy nasoseptal flap if needed; therefore, it is indicated when a CSF leak is possible but not probable. Methods: The early harvested flap was used to reconstruct anterior skull base defects among patients with high-flow on-table CSF leak. Post-operatively the patients were analyzed for CSF leak & bleeding. Results: Of the total 100 patients 87 had macro defects while 13 had micro defects. Non-secretary lesions were present in 60 patients while lesion were present in 40 patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery and majority of them were put on lumbar drain, while bleeding was present in 2% patients. Of the total 100 patients only 2 had post-operative cerebrospinal fluid leak 2%. Conclusion: Use of posterior nasal septal flap for reconstruction of anterior skull base among patients with high-flow intra-operative CSF leak has a remarkable impact in preventing post-operative CSF leak. Its applicability to wide patient-profiles with respect to age, size of defect, diagnosis is making it a versatile choice of reconstruction after endonasal anterior skull base surgeries
The Laryngoscope, 2007
Background: Reconstruction of the skull base after an expanded endonasal approach (EEA) is critical to achieve a good outcome. A novel technique based on the use of a pedicled nasoseptal flap has proven to be a reliable and versatile reconstructive option for extensive defects of the skull base. Data regarding the potential dimensions of a nasoseptal flap are lacking in the literature. This pilot study was developed to help optimize the design of the nasoseptal flap and to ensure that when harvesting the flap, its width and length are adequate to reconstruct the defects that are created by various EEAs.Methods: We analyzed the computed tomographic (CT) scans of four patients who underwent EEAs for skull base lesions. Sagittal and coronal CT reconstructions were generated from axial images. The measurements were divided into skull base measurements, flap dimensions required to cover skull base defects resulting from various EEAs, and potential maximal dimensions of the nasoseptal fla...
Nasal and Skull Base Reconstruction with Turbinate Flaps
Otolaryngology open access journal, 2023
Introduction: The reconstruction of the skull base and nasal mucosa can be performed using different local flaps. The use of the nasoseptal flap is the most common method to reconstruct these areas, but sometimes, due to septal perforations, a history of previous surgeries that may have damaged its pedicle, or because its rotational arc is not ideal, other nasal flaps such as those from the inferior or middle turbinate with their various pedicles may need to be employed. Objectives: The aim of this study was to ascertain the success rate of reconstructions involving the nasal cavity and skull base utilizing inferior and middle turbinate flaps. Methods: Data collected prospectively were analyzed using an Excel spreadsheet for patients who underwent skull base and nasal cavity defect repairs employing turbinate flaps between May 2014 and August 2021. Results: Nine patients were treated and a total of ten reconstructions were performed. Five middle turbinate flaps were executed, two involving medial rotation to address defects situated on the ethmoid roof and three involving lateral rotation to repair a defect within the ethmoid fovea, with two of these flaps closing the frontal ostium. Furthermore, an inferior turbinate flap with a posterior pedicle was utilized to repair the defect resulting from the resection of a meningocele, which was located on the ethmoid roof. Four lateral wall flaps with an anterior pedicle were employed to reconstruct the mucosa of the nasal cavity and to address a defect in the anterior skull base. Conclusion: The reconstruction of anterior skull base defects using turbinate flaps was highly satisfactory, achieving a 100% success rate. The use of lateral wall flaps to repair defects produced by rhinectomies that included resection of the nasal mucosa was also successful and we did not have partial or total necrosis of the flaps. The excellent blood supply to the lateral nasal walls and the ability to dissect these flaps with different arterial pedicles and extend their surface, including the nasal floor, allows for various flap rotations and the reconstruction of defects of different sizes.