Feasibility of the nasoseptal flap for reconstruction of large anterior skull base defects in Asians

Abstract

The lengths of the actual SBDs were longer than those of anticipated SBDs in all patients, while the width of actual SBDs showed less discrepancy. Length and anterior width of the potential SF exceeded the needed SF dimensions in two patients, while the posterior width of potential SF fell short of the needed dimension. In both patients, the length of harvested SF was long enough to repair the entire length of SBD, while shortage of SF width was encountered in one patient.

Radioanatomic study of the skull base and septum in Asians: implications for using the nasoseptal flap for anterior skull‐base reconstruction

“…When an excess of 5 mm of flap sufficiency was considered, the anterior width (18% vs 36%, p = 0.043) and length of the septal flap (62% vs 80%, p = 0.041) was more often insufficient in the Korean female patients. Our results are in accordance with previous radioanatomic studies in which the anterior width showed a higher risk of flap shortage . Koreans, having a smaller septal dimension and yet having similar skull‐base dimensions, are at a higher risk of shortage of the NSF when a big defect needs to be repaired.…”

“…It is also important to avoid or minimize intraoperative shrinkage of the flap. Surgical tips employed by the authors include the use of a cold knife for the septal incisions and applying tagging sutures on the caudal margin of the flap to maintaining an anterior tension instead of pushing it into the nasopharynx . Finally, the surgeon must be familiar with tactics to augment the NSF in the event of a shortage.…”

The radioanatomy of endonasal flap coverage of skull base defects: A tool for preoperative planning

“…A precise value for the margin of error of radioanatomic defects has not been established. A arbitrary margin of 5 to 6 mm is used by some authors; however, because we were unable to find evidence to support the use of this figure we have elected not to use one in our analysis.…”

“…The validity of radioanatomic models for estimating skull base defect and flap size has been established in several studies. 22,23,[28][29][30] A precise value for the margin of error of radioanatomic defects has not been established. A arbitrary margin of 5 to 6 mm is used by some authors 23,29 ; however, because we were unable to find evidence to support the use of this figure we have elected not to use one in our analysis.…”

“…A sixth model, the superior turbinate flap, has been described in a case study, 27 but it was felt this was not sufficient evidence to warrant further analysis. Publications on the radioanatomy of endonasal flaps and SSBDs were also identified, 3,12,22,23,[28][29][30][31][32] which were used to determine the measurements required for each flap and defect. Forty-five measurements were determined, 15 of which were to be taken bilaterally.…”