D A Gol'bin1, N V Lasunin. 1. FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva.
Abstract
BACKGROUND: Buccal fat pad (BFP) is widely used in maxillofacial surgery for closure of oroantral and oronasal defects. V.A. Cherekaev et al. were the first who described application of pedicled BFP flap in reconstruction of anterior and middle skull base defects. This article focuses on a novel surgical technique - plastic closure of craniobasal defects via endonasal endoscopic approach. MATERIAL AND METHODS: We present a case of 12-year old male patient with advanced juvenile angiofibroma who was operated endoscopically using biportal transnasal-transantral approach. After removal of the tumor the defect of anterior cavernous sinus was reconstructed by translocated pedicled BFP flap supported by balloon-catheter. RESULTS: No postoperative complications such as cerebrospinal fluid nasal leakage were observed after withdrawal of balloon-catheter on the 4th day after surgery. The same day the patient was discharged in good condition. CONCLUSION: The proposed technique is promising and advantageous as part of complex multilayer skull base defect reconstruction after resection of extra-intracranial mass lesions due to preserved vascular supply of BFP flap. The method is safe and associated with extremely low risk of complications. We hope that the described flap will be appreciated and will take its place within the range of plastic materials for reconstruction of skull base defects in endoscopic endonasal approach.
BACKGROUND: Buccal fat pad (BFP) is widely used in maxillofacial surgery for closure of oroantral and oronasal defects. V.A. Cherekaev et al. were the first who described application of pedicled BFP flap in reconstruction of anterior and middle skull base defects. This article focuses on a novel surgical technique - plastic closure of craniobasal defects via endonasal endoscopic approach. MATERIAL AND METHODS: We present a case of 12-year old male patient with advanced juvenile angiofibroma who was operated endoscopically using biportal transnasal-transantral approach. After removal of the tumor the defect of anterior cavernous sinus was reconstructed by translocated pedicled BFP flap supported by balloon-catheter. RESULTS: No postoperative complications such as cerebrospinal fluid nasal leakage were observed after withdrawal of balloon-catheter on the 4th day after surgery. The same day the patient was discharged in good condition. CONCLUSION: The proposed technique is promising and advantageous as part of complex multilayer skull base defect reconstruction after resection of extra-intracranial mass lesions due to preserved vascular supply of BFP flap. The method is safe and associated with extremely low risk of complications. We hope that the described flap will be appreciated and will take its place within the range of plastic materials for reconstruction of skull base defects in endoscopic endonasal approach.