A Composite Mucochondral Flap for Skull Base Repair

Radical base of skull surgery and aggressive and expanded endoscopic sinonasal procedures have contributed to the need for repair of skull base defects. Current techniques for the repair involve the use of skeletal grafts, soft tissue on a vascular pedicle, and postoperative buttressing with Gelfoam and nasal packing. We describe a modified technique for treating skull base defects using a composite mucochondral flap from the nasal septum.

In this technique, an island of cartilage from the nasal septum is harvested, maintaining its attachment to the overlying mucosa and mucoperichondrium as well as a vascular pedicle. The cartilage is sculpted to snap into the defect and be self-locking while the mucosal segment is kept larger and covers the cartilage. A fat graft may be placed to obliterate dead space. The composite flap is then rotated into position to plug the defect.

A major advantage of this technique is that it provides a solid vascularized skeletal support as opposed to a graft covered by mucoperichondrium. In addition, because the flap is constructed with attached mucosa, there is no need for further tacking, and postoperative buttressing is not typically necessary. Our group has successfully treated five patients with this technique without complication, and all septal donor sites fully healed without issue.