Nasal Deformities following Nasoseptal Flap Reconstruction of Skull Base Defects

Rowan, Nicholas R.; Wang, Eric; Snyderman, Carl H.

doi:10.1055/s-0035-1546496

Cited by 8 publications

(21 citation statements)

References 5 publications

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“…Based on more recent reports, the incidence of structural complications is exceedingly rare. In a series of 328 consecutive patients, Rowan et al . identified that nasal dorsal collapse, possibly related to devascularization of septal cartilage, was present in 19 (5.8%) patients, while septal perforation occurred in 3 (0.9%) patients, with all complication associated with CSF use.…”

Section: Complicationsmentioning

confidence: 90%

“…Overall, the scope of complications associated with local and regional vascular flaps generally fall within 3 categories: flap integrity, recipient site complications, and donor‐site complications . A review of institutional complications by Soudry et al .…”

Section: Reconstructionmentioning

confidence: 99%

“…The structural integrity of the nasal septum may be compromised in a notable percentage of patients undergoing septal flap reconstruction. Septal perforation has been reported at rates approaching 14%, whereas nasal dorsum collapse has been reported in nearly 16% of cases …”

Section: Reconstructionmentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

160

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Complicationsmentioning

confidence: 90%

Section: Reconstructionmentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

160

279

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“…7 Although most publications found that nasoseptal flap doesn't produce long-term effects in nasal function if it is adequately performed, 8 there are recent publications that relate the nasoseptal flap to olfactory dysfunction and a low possibility of nasal deformation. 9 Anyway, it is always better to reduce manipulation or destruction of normal structures. The rescue flaps allow to minimize mucosa and septal manipulation while keeping the possibility of harvesting a flap when needed.…”

Section: Discussionmentioning

confidence: 99%

Direct Endonasal Approach with Partial Upper Posterior Septectomy. A “Rescue Flap” Technique Modification

et al. 2016

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Objective?Report a modification of the ?rescue flap? technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution. Design?Prospective study. Setting?Hospital Universitario ?Dr. Jos? Eleuterio Gonz?lez,? Universidad Aut?noma de Nuevo Le?n. Main Outcome Measures?Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below. Results?Nineteen patients were included in this report. Six patients presented transoperatory cerebrospinal fluid (CSF) leak, so a nasoseptal rescue flap was harvested. No patients developed postoperative CSF leak in this group. Two patients were submitted to a second surgical procedure. Nasoseptal flap was harvested without complications. In both patients, the size of the flap was enough to cover the dural defect and avoid CSF leak. Conclusion?Direct endonasal approach with a partial posterior septectomy allows enough exposition of the sphenoidal sinus while preserving the nasoseptal septum with the possibility of a successful rescue flap when needed.

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“…Rowan et al found a 5.8% rate of dorsum collapse and a 0.9% rate of septal perforation. 13 Soyka et al and Soudry et al found rates of septal perforation of 14.4 and 10%, respectively. 6,7 Quality of Life Outcomes (QoL) assessing risk of bias (►Table 5).…”

Section: Nasal Deformitymentioning

confidence: 93%

Complications of Nasoseptal Flap Reconstruction: A Systematic Review

et al. 2018

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The nasoseptal flap (NSF) is considered the primary vascularized flap for reconstruction of dural defects with endoscopic endonasal surgery (EES) of the skull base. However, the complications and morbidities associated with this reconstructive flap are poorly understood. This article presents a systematic review of the complications and morbidities related to the use of the NSF in skull base surgery. A systematic review of the literature based on published guidelines was performed to identify potential complications and morbidities related to the NSF. The MEDLINE and Embase databases were searched from January 1, 1950 to February 5, 2018. Twenty-seven articles were identified. Reported complications were as follows: NSF necrosis (4 studies; [0-1.3%]), mucocele formation (5 studies; [0-3.6%]), septal perforation (6 studies, [0-14.4%]), nasal dorsum collapse (2 studies, [0.7-5.8%]), effects on quality of life (QoL) (8 studies), and olfactory loss (11 studies). Although complications associated with the NSF may be underreported in the literature, the NSF appears to be a safe and reliable reconstructive flap in EES of the skull base.

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Nasal Deformities following Nasoseptal Flap Reconstruction of Skull Base Defects

Cited by 8 publications

References 5 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Direct Endonasal Approach with Partial Upper Posterior Septectomy. A “Rescue Flap” Technique Modification

Complications of Nasoseptal Flap Reconstruction: A Systematic Review

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