Anteriorly Based Inferior Turbinate Flap for Endoscopic Skull Reconstruction

Objective: In the absence of the nasal septal flap, there is a limited ability to reconstruct the anterior skull base due to paucity of alternative intranasal vascularized flaps. In this paper, we describe for the first time the anterior pedicled inferior turbinate flap (AITF) as a method for endonasal reconstruction of anterior skull base defects.

Study Design: A prospective review was conducted of the demographic, clinical, surgical, and early follow-up data of five patients who underwent reconstruction of skull defects by the AITF approach.

Methods: The nature of the arterial blood supply of the inferior turbinate from the sphenopalatine artery, the anterior ethmoidal artery (AEA), and the lateral nasal artery was exploited to design an anteriorly pedicled flap. AITF survival, graft coverage, adequacy of the seal, and rate of complications were assessed.

Results: Five patients were suitable to undergo anterior skull base reconstruction using the AITF after tumor resections of CSF leak. Each had a high-flow intraoperative CSF leak. The reconstruction achieved full covering of the skull base defect from the frontal sinus to the planum sphenoidale in each case, with no postoperative CSF leaks or any other complications.

Conclusion: The AITF approach is simple to execute and can be safely and effectively used for endonasal reconstruction of anterior skull base defects, especially when traditional reconstruction techniques are not possible.