Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique using a Posterior Septal Free Mucosal Graft

Yoo, Frederick; Kuan, Edward C.; Bergsneider, Marvin; Wang, Marilene

doi:10.1055/s-0036-1579831

Cited by 6 publications

(10 citation statements)

References 7 publications

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“…1,8,9 However, donor site morbidity following NSF harvest is potentially very bothersome for patients, with certain reports of prolonged nasal crusting lasting for weeks to months. 10,11 Though several donor site reconstructive options have been reported, such as the use of fascia lata, 12 free septal 4 or middle turbinate 13 mucosal graft, or "reverse" flap, 14 careful selection of reconstructive options prior to flap harvest remains the best way to minimize morbidity. Initially, several grades 0 and 1 intraoperative CSF leaks were primarily reconstructed using NSF.…”

Section: Discussionmentioning

confidence: 99%

“…In following these patients postoperatively in the outpatient setting, there is anecdotal evidence suggesting improved wound healing, without significantly added morbidity from the graft donor site. 4 Nevertheless, mucosal grafting outcomes on sinonasal symptoms are unknown and are needed to determine the true value of this technique. For high-grade leaks, we usually resort to the NSF, which has become the workhorse flap for anterior skull base reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…At the end of the resection, the FMG is placed over the denuded bone (or, in the case of RCC, within the inferior portion of the marsupialized tract 3 ) in an effort to promote remucosalization. 4…”

Section: Free Mucosal Grafting Techniquementioning

confidence: 99%

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An Algorithm for Sellar Reconstruction Following the Endoscopic Endonasal Approach: A Review of 300 Consecutive Cases

et al. 2017

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The endoscopic endonasal approach (EEA) is the workhorse endoscopic procedure for sellar and parasellar pathology. Various reconstruction techniques have been reported following EEA surgery, ranging from no reconstruction to vascularized flaps. We review our institution's experience with sellar reconstruction following EEA and propose an evidence-based algorithm. Retrospective review. Tertiary academic medical center. Patients who underwent endoscopic EEA surgery for sellar or parasellar pathology between March 1, 2013 and August 31, 2016. Patient demographic and clinicopathologic data were collected. Outcome measures included intraoperative and postoperative cerebrospinal fluid (CSF) leak rates and extent of resection (gross or subtotal). Three hundred consecutive patients were included. Depending on the presence and grade of intraoperative CSF leak, cases were reconstructed using either a free mucosal graft (FMG) or nasoseptal flap (NSF). Intraoperative and postoperative CSF leak rates were 30.7% and 2.3%, respectively. Multivariable logistic regression found that intraoperative CSF leak was associated with recurrent disease (odds ratio [OR] 2.47, = 0.004), with no apparent predictors of postoperative CSF leak. Based on this large series, we propose the following algorithm for sellar reconstruction: FMG for no CSF leak; fat graft + FMG ± rigid fixation for low-grade leaks; and fat graft + NSF ± rigid fixation for high-grade leaks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Algorithm for Sellar Reconstruction Following the Endoscopic Endonasal Approach: A Review of 300 Consecutive Cases

et al. 2017

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“…reported improvements in postoperative nasal symptom scores with middle turbinate preservation, limiting the approach to transnasal (ie, no dissection of maxillary and sphenoid sinuses), and reducing NSF utilization whenever possible. One may also consider secondary coverage of the exposed cartilage, either in the form of a “reverse flap” or free mucosal graft, to promote rapid remucosalization.…”

Section: Complicationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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“…39 The NSF donor site heals by secondary intention and can result in significant crusting for up to 12 weeks postoperatively. 16,27,40 While septal crusting may not last any longer than the expected postoperative sinonasal crusting, 16,41 it can affect the internal nasal valve and contribute to symptomatic nasal obstruction. Several solutions to expedite septal healing have been described, such as silicone splinting, free grafting (mucosa or fascia lata), and the reverse rotation flap described by Caicedo et al [41][42][43] Overall, the quality of evidence is low with most studies designed as cohort studies with high potential for selection bias (►Table 5) or case series.…”

Section: Discussionmentioning

confidence: 99%

Complications of Nasoseptal Flap Reconstruction: A Systematic Review

et al. 2018

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The nasoseptal flap (NSF) is considered the primary vascularized flap for reconstruction of dural defects with endoscopic endonasal surgery (EES) of the skull base. However, the complications and morbidities associated with this reconstructive flap are poorly understood. This article presents a systematic review of the complications and morbidities related to the use of the NSF in skull base surgery. A systematic review of the literature based on published guidelines was performed to identify potential complications and morbidities related to the NSF. The MEDLINE and Embase databases were searched from January 1, 1950 to February 5, 2018. Twenty-seven articles were identified. Reported complications were as follows: NSF necrosis (4 studies; [0-1.3%]), mucocele formation (5 studies; [0-3.6%]), septal perforation (6 studies, [0-14.4%]), nasal dorsum collapse (2 studies, [0.7-5.8%]), effects on quality of life (QoL) (8 studies), and olfactory loss (11 studies). Although complications associated with the NSF may be underreported in the literature, the NSF appears to be a safe and reliable reconstructive flap in EES of the skull base.

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Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique using a Posterior Septal Free Mucosal Graft

Cited by 6 publications

References 7 publications

An Algorithm for Sellar Reconstruction Following the Endoscopic Endonasal Approach: A Review of 300 Consecutive Cases

An Algorithm for Sellar Reconstruction Following the Endoscopic Endonasal Approach: A Review of 300 Consecutive Cases

ICAR: endoscopic skull‐base surgery

Complications of Nasoseptal Flap Reconstruction: A Systematic Review

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