Anterior pedicle lateral nasal wall flap: A novel technique for the reconstruction of anterior skull base defects

Abstract

The HB2 flap is a feasible alternative for the reconstruction of anterior skull base defects in select patients.

The posterior pedicled inferior turbinate–nasoseptal flap: a potential combined flap for skull base reconstruction

“…Free grafts and currently used intranasal flaps [e.g., HBF [11], posterior and anterior pedicled ITFs [1,8,10], middle turbinate flap [25], anterior pedicled lateral nasal wall flap [12], bipedicled anterior septal flap [3]] are inadequate for large skull base defects resulting from EEAs (especially combined approaches) [8], for which reconstruction with vascularized tissue has been inferior turbinate arteries, d1 lower nasal septal artery, d2 medial nasal septal artery, d3 upper nasal septal artery, e1, e2 arteries branching from the PLNA that anastomose the inferior turbinate artery and nasal septal artery networks, f branches of the anterior ethmoid artery, g branches from the branches of the facial artery shown to be fundamental in reducing the incidence of CSF leakage. The use of regional flaps is limited by the difficulty of their creation and application [7,28].…”

“…Technological advances, improved anatomic understanding of skull base relationships from an endoscopic perspective, and rapidly growing surgical experience have led to the resection of larger and more complex lesions in the median and paramedian skull base via endoscopic expanded endonasal approaches (EEAs) [7,8,11,12]. Skull base defects resulting from EEAs, especially the resection of intradural lesions, however, are associated with significant risks of postoperative cerebrospinal fluid (CSF) leakage, pneumocephalus, and meningitis.…”

“…Skull base defects resulting from EEAs, especially the resection of intradural lesions, however, are associated with significant risks of postoperative cerebrospinal fluid (CSF) leakage, pneumocephalus, and meningitis. The challenge of reconstructing such defects has hindered the acceptance and popularization of EEAs [11,12,16]. Thus, the development of reliable reconstructive techniques that maximize EEA efficacy and minimize complications is critical [4,16,17,19,25].…”

The inferior turbinate flap in skull base reconstruction

“…The estimated surface area of the PPITF is 2.4 ± 1.0 cm 2 5.4 cm length by 2.2 cm width) [25]. However, additional mucosa extending beyond the lateral nasal wall, including the mucoperiosteum of the inferior lateral wall, inferior meatus, and nasal floor, can be harvested to increase the surface area of the flap [6,27]. It has been suggested that the surface area of these enlarged flaps may be three times greater than the PPITF [6].…”

Salpingopharyngeus Myomucosal Flap

“…[4][5][6][7] Reconstruction with vascular pedicled flaps has been proven revolutionary in preventing postoperative complications, as vascularized tissues seem to be more reliable for the repair of large CSF leaks created by endoscopic endonasal skull base surgery. 2,4,8,11 The salpingopharyngeus muscle originates from the lateral lamina of Eustachian tube (ET; torus tubarius) (Fig. Exposure leads to desiccation, potential blowout of the vessel, and pseudoaneurysm, especially in patients who received radiation therapy.…”