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Modified Posterior Pedicle Middle Turbinate Flap: An Additional Option for Skull Base Resurfacing
Author(s) -
Pistochini Andrea,
Russo Federico,
Coden Elisa,
Sileo Giorgio,
Battaglia Paolo,
Bignami Maurizio,
Volpi Luca,
Castelnuovo Paolo
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29099
Subject(s) - clivus , medicine , skull , middle cranial fossa , dissection (medical) , base of skull , surgery , posterior cranial fossa , anatomy
Objectives/Hypothesis Although the Hadad‐Bassagusteguy flap represents the first choice for middle and posterior skull base reconstruction and coverage of exposed bony areas, in some cases it is unavailable. The aim of this study is to describe, as an alternative option in selected cases, a modified posterior pedicle middle turbinate flap (mPPMTF) extended to the lacrimal area. Anatomical features, step‐by‐step harvesting technique, and surgical applications are presented. Study design Anatomic dissection study and case report. Methods Four mPPMTFs were raised in two fresh‐frozen cadaver heads. A study of the vascular supply and measurements of length, width, and area of the flap were performed. The ability of the flap to cover the ventral skull base, particularly the upper clivus area, was tested. A clinical case in which an mPPMTF was used for clivus resurfacing after osteoradionecrosis is reported. Results The vascular supply of the mPPMTF was identified as the middle turbinate branch of the sphenopalatine artery. The flap had a mean length of 6.92 cm, mean maximum width of 1.08 cm, and mean total area of 5.33 cm 2 . The flap was able to reach the upper clivus, with a clival coverage ratio of 70.66%. In the clinical case, good surgical outcomes were observed, with accelerated re‐epithelization without complications. Conclusions The mPPMTF represents an alternative to the Hadad‐Bassagusteguy flap for posterior cranial fossa and nasopharynx resurfacing. The main drawbacks are its technically demanding and time‐consuming harvesting. Level of Evidence 4 Laryngoscope , 131:E767–E774, 2021