Mathieu Veyrat1, Benjamin Verillaud1, Philippe Herman1, Damien Bresson2. 1. Department of Head and Neck Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Hôpital Lariboisière; 2, rue Ambroise Paré, 75010, Paris, France. 2. Department of Neurosurgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France. damien.bresson@aphp.fr.
Abstract
BACKGROUND: Endoscopic endonasal approaches (EEA) are an alternative for removing challenging nasopharyngeal or skull base lesions. In some cases, a nasoseptal flap (NSF) is not always available and such complex procedures may lead to carotid arteries exposition and/or dura mater (DM) wide opening. Meticulous carotid coverage and DM reconstruction are crucial for preventing early and delayed complications. METHOD: We propose a step-by-step description of the pedicled temporoparietal fascia flap (TPFF) technique, with a focus on its pitfalls, advantages and limits. CONCLUSION: The TPFF is a reliable flap for skull base reconstruction when other pedicled flaps are not available. KEY POINTS: 1. Reliable flap even for irradiated patients 2. CT angiography with 3D reconstruction as pre-operative imaging 3. Doppler ultrasound probe to draw the artery's trajectory on skin 4. TPFF elevation concomitantly to the endoscopic procedure 5. Hemicoronal incision sufficient to harvest the TPFF 6. Superficial dissection in a plane just beneath the hair follicles 7. Dissection plane deep to the fad pad to preserve the frontal branch of the facial nerve 8. Surgical corridor wide enough to avoid any compression of the pedicle 9. Double visualization to avoid any twist and Doppler control of the STA patency 10. Close follow-up, toilet in clinics.
BACKGROUND: Endoscopic endonasal approaches (EEA) are an alternative for removing challenging nasopharyngeal or skull base lesions. In some cases, a nasoseptal flap (NSF) is not always available and such complex procedures may lead to carotid arteries exposition and/or dura mater (DM) wide opening. Meticulous carotid coverage and DM reconstruction are crucial for preventing early and delayed complications. METHOD: We propose a step-by-step description of the pedicled temporoparietal fascia flap (TPFF) technique, with a focus on its pitfalls, advantages and limits. CONCLUSION: The TPFF is a reliable flap for skull base reconstruction when other pedicled flaps are not available. KEY POINTS: 1. Reliable flap even for irradiated patients 2. CT angiography with 3D reconstruction as pre-operative imaging 3. Doppler ultrasound probe to draw the artery's trajectory on skin 4. TPFF elevation concomitantly to the endoscopic procedure 5. Hemicoronal incision sufficient to harvest the TPFF 6. Superficial dissection in a plane just beneath the hair follicles 7. Dissection plane deep to the fad pad to preserve the frontal branch of the facial nerve 8. Surgical corridor wide enough to avoid any compression of the pedicle 9. Double visualization to avoid any twist and Doppler control of the STA patency 10. Close follow-up, toilet in clinics.
Authors: Hannah Daoudi; Marc A Labeyrie; Sophie Guillerm; Sylvie Delanian; Jean-Pierre Guichard; Clément Jourdaine; Sandrine Faivre; Helene Gauthier; François-Régis Ferrand; Benjamin Verillaud; Philippe Herman Journal: Laryngoscope Investig Otolaryngol Date: 2020-01-22
Authors: Bin Ren; Oliver B Betz; Daniel Seitz; Christian Thirion; Michael Salomon; Volkmar Jansson; Peter E Müller; Volker M Betz Journal: Int J Mol Sci Date: 2022-02-28 Impact factor: 5.923