Middle turbinate flap for skull base reconstruction: Cadaveric feasibility study

Abstract

Harvesting of a vascular pedicle flap from the MT is feasible, albeit technically demanding. It should be considered as an alternative for the reconstruction of small defects of the fovea ethmoidalis, planum, and sella, particularly for patients for whom a reconstruction with vascularized tissue is desirable but the nasoseptal flap is not available.

Advances in Reconstruction of the Skull Base

“…Radioanatomic studies and clinical case series have proven that the NSF can cover anterior cranial fossa, transsphenoidal, and transclival defects independently for patients greater than 14 years of age, with an average coverage of 25 cm 2 of surface area. [12][13][14] The NSF enjoys a high degree of success after skull base reconstruction (95 % and greater), and has reliably been used in multiple institutions and countries [15,16]. Modifications of the NSF have provided a myriad of reconstructive options with high success rates, from takedown and reuse of the NSF during revision surgery years after the primary surgery (95 %) [17], to creating a bilateral ''Janus flap'' for an extremely large dural defect (100 %) [18], to partial harvest of the NSF as a nasoseptal ''rescue'' flap (NSRF) to be used only in case of CSF leak (100 %) [19 • ].…”

“…Cadaveric studies have shown that the ITF may cover the anterior skull base from the posterior table of the frontal sinus to the sella, with an average of 4.97 cm 2 surface area coverage [14,25]. The major disadvantages of the ITF are the decrease in surface area that the ITF can provide for skull base repair and the decrease in length for flap placement as compared to other locoregional vascularized flaps [24,26,27].…”

“…The MTF is a flap pedicled on branches of the sphenopalatine artery, along with branches of the anterior septal arteries [14]. The MTF is adequate to provide coverage for transplanar, transtubercular, and/or transsellar defects, and can provide an average 5.6 cm 2 of surface area coverage [14].…”

“…The MTF is adequate to provide coverage for transplanar, transtubercular, and/or transsellar defects, and can provide an average 5.6 cm 2 of surface area coverage [14]. The disadvantage of the MTF lies in its smaller surface area coverage, the highly variable pneumatization of the middle turbinate, and the presence of bullous turbinates [28].…”

Tetrahedral silicon balloon for endoscopic skull base reconstruction

“…[10][11][12][13][14] Use of a nasal septal flap (NSF) has reduced the rate of complications and allowed increasing numbers of patients with skull base neoplasms to undergo curative surgical resections by means of minimally invasive techniques. 15 One drawback of this technique is the difficulty of stabilizing the multilayered reconstruction in place after its application.…”