Middle Turbinate Vascularized Flap: Applications in Skull Base Reconstruction

Otto, Bradley A.; Carrau, Ricardo L.; Prevedello, Danielle M.; Old, Matthew; Filho, Leo F. Ditzel; Lara, Danielle de; Mafaldo, Rodrigo Cadore

doi:10.1055/s-0032-1312200

Cited by 2 publications

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“…8 None among the 5 patients treated by Otto et al, developed postoperative CSF leak; In a study of 18 patients using MTF by Marks, there was 100% initial graft uptake and 94% on the longer run. 9,10 In our series, none of the 20 patients developed CSF leak on long term follow-up and repair deemed successful in all cases (100%). 1 patient who developed transient postoperative CSF leak had a sellar defect.…”

Section: Discussionmentioning

confidence: 61%

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

George

Suresh

2016

Int J Otorhinolaryngol Head Neck Surg

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Background: 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.Methods: 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. Results: 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%]).Conclusions: 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.

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Section: Discussionmentioning

confidence: 61%

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

George

Suresh

2016

Int J Otorhinolaryngol Head Neck Surg

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“…To date, use of MTFs for the reconstruction of skull base defects in patients has been reported in seven studies with a combined total of 51 patients. [48][49][50][51][52][53][54] All but one reported case were considered successful and were without long-term CSF leaks, infection, pneumocephalus, or significant crusting. The one incidence of MTF failure was due to a necrotic MTF following a failed NSF.…”

Section: Mtf Outcomesmentioning

confidence: 99%

Vascular pedicled flaps for skull base defect reconstruction

Gutierrez

Bennion

Walsh

et al. 2020

Laryngoscope Investig Oto

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Objective: Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. Methods: A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. Results: The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a "rescue" nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. Conclusion: Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care.

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Middle Turbinate Vascularized Flap: Applications in Skull Base Reconstruction

Cited by 2 publications

References 0 publications

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

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

Vascular pedicled flaps for skull base defect reconstruction

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