Middle turbinate mucosal flap: A low‐morbidity option in the management of skull base defects

Head & Neck ◽  
2021 ◽  
Author(s):  
Claudio Carnevale ◽  
Guillermo Til‐Pérez ◽  
Manuel Tomás‐Barberán ◽  
Javier Ibañez‐Domínguez ◽  
Diego Arancibia‐Tagle ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Mucosal Flap ◽  
Skull Base Defects

scholarly journals Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

2017 ◽  
Vol 31 (04) ◽  
pp. 203-213 ◽  
Author(s):  
Srikant Chakravarthi ◽  
Lior Gonen ◽  
Alejandro Monroy-Sosa ◽  
Sammy Khalili ◽  
Amin Kassam
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Reconstruction Algorithm ◽  
Inferior Turbinate ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Fascial Flap ◽  
Skull Base Defects ◽  
Reconstructive Techniques ◽  
Csf Leaks

AbstractThe success of expanded endoscopic endonasal approaches (EEAs) to the anterior skull base, sellar, and parasellar regions has been greatly aided by the advancement in reconstructive techniques. In particular, the pedicled vascularized flaps have been developed and effectively cover skull base defects of varying sizes with a significant reduction in postoperative CSF leaks. There are two aims to this review: (1) We will provide our current, simplified reconstruction algorithm. (2) We will describe, in detail, the relevant anatomy, indications/contraindications, and surgical technique, with a particular emphasis on the nasoseptal flap (NSF). The inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF) will also be described. The NSF should be the primary option for reconstruction of majority of skull base defects following endonasal endoscopic surgery. In general, for the planum, cribriform, and upper two-thirds of the clivus, the NSF is ideal. For the lower-third of the clivus, the NSF may not be adequate and may require additional reconstructive options. Although limited in reach or more technically challenging, these reconstructive flaps should still be considered and kept in the surgical algorithm.

scholarly journals Outcomes of Middle Turbinate Flap in the Reconstruction of Non-tumorous Ventral Skull Base Defects - an Institutional Review

2021 ◽  
Vol 58 (4) ◽  
pp. 214-219
Author(s):  
Vinoth Manimaran ◽  
◽  
Somu Lakshmanan ◽  
Aishwarya Prateep ◽  
Ramya Baburajan ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Institutional Review ◽  
Ventral Skull Base ◽  
Skull Base Defects

scholarly journals Vascularized middle turbinate mucoperiosteal flap in skull base defects: follow-up analysis of 20 cases

2016 ◽  
Vol 3 (1) ◽  
pp. 71 ◽  
Author(s):  
Shibu George ◽  
Sandeep Suresh
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Middle Turbinate ◽  
Benign Intracranial Hypertension ◽  
Nasoseptal Flap ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
Mucoperiosteal Flap ◽  
Skull Base Defects

<p class="abstract"><strong>Background:</strong> Vascularized flaps are preferred in repair of skull base defects since they provide quality tissue volume and allow rapid healing. Though nasoseptal flap is the gold standard it may not be available always and has its own share of pitfalls; this makes the middle turbinate flap a viable alternative. This descriptive study was designed to analyze the efficacy of middle turbinate flap in endoscopic closure of skull base defects and to define indications and limitations of the flap.</p><p class="abstract"><strong>Methods:</strong> 20 patients who underwent endoscopic closure of small and medium sized skull base defects using middle turbinate mucoperiosteal flap were analyzed and followed up. Etiology, presentation, site and co-morbidities associated with such defects were studied. Effectiveness of closure was analyzed by the ability to cover fully, graft uptake and complications.  </p><p class="abstract"><strong>Results:</strong> Successful flap take up was noted in all 20 cases (100%) on long term follow up; transient cerebrospinal fluid leak was observed in 1case (5%) during the immediate post-operative period which subsided fully. Spontaneous CSF rhinorrhea (n=11 [55%]) was the most common indication for closure and unilateral watery rhinorrhea was the commonest presentation (n=13 [65%]). Benign intracranial hypertension was found to have significant association with cerebrospinal fluid rhinorrhea. Most common site of leak was the medial lamella of cribriform plate (n=11 [55%]).</p><p><strong>Conclusions:</strong> Middle turbinate flap is an effective alternative to nasoseptal flap for small and medium sized anterior skull base defects; efficacy in larger defects and posterior sellar defects cannot be substantiated. </p>

scholarly journals Applying middle turbinate mucosal flap in endoscopic surgery of skull base reconstruction

2012 ◽  
Author(s):  
Wang Xuejian ◽  
Xiaobiao Zhang ◽  
Fan Hu ◽  
Yong Yu ◽  
Ye Gu ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Surgery ◽  
Middle Turbinate ◽  
Skull Base Reconstruction ◽  
Mucosal Flap

scholarly journals Single Layer Repair of Large Anterior Skull Base Defects without Vascularized Mucosal Flap

2016 ◽  
Vol 78 (02) ◽  
pp. 139-144 ◽  
Author(s):  
Marilene Wang ◽  
Marvin Bergsneider ◽  
Jeffrey Suh ◽  
Frederick Yoo
Keyword(s):  
Skull Base ◽  
Single Layer ◽  
Anterior Skull Base ◽  
Mucosal Flap ◽  
Skull Base Defects

Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital

2019 ◽  
Vol 133 (10) ◽  
pp. 889-894
Author(s):  
C Carnevale ◽  
M Tomás-Barberán ◽  
G Til-Pérez ◽  
J Ibañez-Domínguez ◽  
D Arancibia-Tagle ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Middle Turbinate ◽  
Cerebrospinal Fluid Leak ◽  
Lateral Wall ◽  
Anterior Skull Base ◽  
University Hospital ◽  
Endoscopic Reconstruction ◽  
Skull Base Defects ◽  
Fluid Leak

AbstractBackgroundThe indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.MethodA prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.ResultsTwenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).ConclusionThe combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

Treatment of anterior skull base defects by a transnasal endoscopic approach in children

2010 ◽  
Vol 6 (5) ◽  
pp. 459-463 ◽  
Author(s):  
Federico Di Rocco ◽  
Vincent Couloigner ◽  
Patricia Dastoli ◽  
Christian Sainte-Rose ◽  
Michel Zerah ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Anterior Skull Base ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Endoscopic Management ◽  
Tertiary Referral Center ◽  
Transnasal Endoscopic Approach ◽  
Skull Base Defect ◽  
Skull Base Defects

Object The object of this study was to assess the efficacy and complications of endoscopic management of anterior skull base defects. Method The authors reviewed the medical records of 28 children (20 boys and 8 girls) undergoing endoscopic repair of anterior skull base defects in their tertiary referral center between 2001 and 2008; 18 cases were congenital and 10 cases posttraumatic. During the endoscopic procedure, rigid telescopes—2.7 or 4 mm in diameter, with 0° or 30° lenses—were used. In 23 patients the anterior skull base defect was sealed with fragments of middle turbinate (bone and mucosa). In the remaining 5 patients it was sealed with cartilage harvested from the nasal septum (3 cases) or from the auricle (2 cases), fibrin glue, and oxidized cellulose. A combined external and endoscopic approach was required in 3 cases because of the size and extensions of the encephalocele. Outcome was primarily assessed by means of clinical examination, nasal fibroscopy, and imaging. Results The mean duration of follow-up was 26.7 months (range 9–57 months). One patient treated by a combined approach died of meningitis 2 years after surgery. In the remaining 27 patients, there was no recurrence of CSF leak, meningitis, or encephalocele. An iatrogenic frontal or ethmoidal mucocele was observed in 4 cases. Conclusions The endoscopic approach is a minimally invasive, safe, and efficient technique for removing nasal encephaloceles in children.

Sign in / Sign up

Export Citation Format

Share Document