Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study

Abstract

Introduction: The aim of this radio-anatomical study is to ensure that the potential donor area of the pedicled lateral nasal wall flap (PLNW) is adequate to reconstruct nasal perforation. Material and methods: Analysis was conducted on 40 de-identified CT angiographies. The area and length of the PLNW, the septum, and the nasal floor were measured. In a cadaver study, 20 hemi-cranial sagittal sections were also analyzed. The anterior-posterior length of the PLNW flap and the distance between the sphenopalatine foramen and piriform aperture were measured. A clinical study with endoscopic closure of a large perforation was conducted in three patients. Results: The CT angiographies demonstrated an average PLNW area of 10.80±1.13 cm2 and a nasal floor area of 3.78±0.58 cm2. The septal area (22.54±21.32 cm2) was significantly larger than the total PLNW flap area (14.59±1.21 cm2). The average length of the flap was 5.58±0.39 cm, while the septum was 6.66±0.42 cm; therefore the PLNW flap is insufficient to reconstruct the entire septum. The cadaver study showed that the length of the PLNW flap was 5.28±0.40 cm. These results demonstrate that measurements obtained from CT scans are reliable data and similar to those found in the radiological study. Complete closure was achieved in all three patients. Conclusion: The PLNW flap does not render enough tissue to reconstruct a total septal perforation; however, up to 84% of the septum could be repaired with a PLNW. The potential donor area obtained by CT scan and clinical practice support the approachability of PLNW to repair large septal perforation.

The role of endoscopic endonasal approach in the multimodal management of giant pituitary adenoma: Case report and literature review

“…Nevertheless, in the last years, the cerebrospinal fluid (CSF) leak rate has dramatically improved thanks to the implementation of pedicled nasoseptal flap. [25][26][27] In the existing literature, a gross total removal of GPA is described in only 50% of cases; [6,12] because subtotal resection may be associated with early postoperative hemorrhages, acute hydrocephalus, and persistent optic nerve compression, a multimodal approach is warranted in most cases which can lead to a control of the disease as happened in this case report. In fact, the concomitant use of pharmacological therapy and radiotherapy or radiosurgery could become more relevant in the future thanks to advances obtained with the introduction of radioenhancers and radiosensitizers.…”

State-of-the-art: septal perforation repair

“…Posteriorly based flap is based on the branches of the posterolateral nasal artery. The major disadvantage is the requirement for a second step to release the pedicle [4,24].…”

Endoscopically Assisted Repair of Nasal Septal Perforation Using Platelet Rich Plasma

“…Most techniques are based on the pedicledendonasal flaps, which can be used to repair small-medium septal perforations. Endonasal flaps include the bridgeflap [9], inferior turbinate flap [10], inferior meatal flap [7,8]anterior ethmoidal artery flap [11], lateral nasal wall flap [12], and middle turbinate flap [13]. Nevertheless, in large perforations, a flap such as the pericranial flap for complete closure may be necessary [14].…”