Ziv Gil1, Nevo Margalit. 1. The Head and Neck Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Israel Tel Aviv, Israel. ziv@baseofskull.org
Abstract
OBJECTIVE: In 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 DESIGN: A 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. SETTING: An academic cancer center. METHODS: The 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. RESULTS: Seven 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 cerebrospinal fluid (CSF) leak. The reconstruction achieved covering of the anterior skull base, including the frontal sinus and cribriform plate, with no postoperative CSF leaks or any other complications. CONCLUSION: The AITF is well tolerated and is associated with good outcomes. Its length and angle of rotation allow reconstruction of skull base defects in the posterior frontal sinus wall and cribriform plate, especially when traditional reconstruction techniques are not possible.
OBJECTIVE: In 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 DESIGN: A 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. SETTING: An academic cancer center. METHODS: The 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. RESULTS: Seven 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 cerebrospinal fluid (CSF) leak. The reconstruction achieved covering of the anterior skull base, including the frontal sinus and cribriform plate, with no postoperative CSF leaks or any other complications. CONCLUSION: The AITF is well tolerated and is associated with good outcomes. Its length and angle of rotation allow reconstruction of skull base defects in the posterior frontal sinus wall and cribriform plate, especially when traditional reconstruction techniques are not possible.
Authors: Jonathan Yip; Kristian I Macdonald; John Lee; Ian J Witterick; Gelareh Zadeh; Fred Gentili; Allan D Vescan Journal: J Otolaryngol Head Neck Surg Date: 2013-01-31