An Alternative Way of Learning Intranasal Pedicled Flap: Correlation of 3D Anatomy Models and Surgical Techniques with Radiographic Images and Case Studies

Introduction: Expanded endoscopic approaches(EEA) of resection of either benign or malignant skull base tumors lead to rapid evolution of techniques in reconstruction of skull base defect. So far, reconstruction with vascular pedicled flap has the most promising outcome with postoperative cerebrospinal fluid(CSF) leak rate of less than 5%. Up to date, various techniques of intranasal pedicled flap have been introduced. They consist of: 1. Hadad-Bassagestegay nasoseptal flap, 2. Posterior pedicled inferior turbinate flap, 3. Posterior pedicled middle turbinate flap, 4. Posterior pedicle lateral nasal wall flap(Carrau-Hadad), 5. Anterior pedicled lateral nasal wall flap(Hadad-Bassegaisteguy2), 6. Nasoseptal rescue flap and 7. Reverse rotation flap. A prolonged learning curve is expected to master these surgical techniques. Hence, an alternative method of interactive learning with 3D anatomy models combined/correlated with radiographic images and clinical cases will shorten this learning curve.

Objective: To illustrate an alternative way of learning intranasal pedicled flaps by correlating 3D anatomy models and surgical techniques with radiographic images and case studies.

Materials & Methods: Interactive 3D anatomy models of different types of intranasal pedicled flap were correlated with pre- and post-operative radiographic images and case studies to illustrate the surgical techniques and indications of different types of intranasal pedicled flap in skull base reconstructive surgery.

Results: Interactive 3D anatomy models correlated with radiographic images and case studies were developed for seven different types of intranasal pedicled flap. The surgical techniques with special emphasis on surgical landmarks were illustrated. The neurovascular bundle of each pedicled flap was highlighted. Every model allows layers of anatomy to be added or removed. Every model can be rotated 360 degrees or tipped allowing user to view and label any structures.

Conclusions: This new interactive 3D anatomy models correlated with radiographic images and case studies is an alternative way of learning intranasal pedicled flap.