Free Middle Turbinate Mucosal Grafts for Reconstruction of Septal Donor Site after Harvesting Nasoseptal Flap in Endoscopic Endonasal Pituitary Surgery

Introduction: The nasoseptal flap is now a popular flap for reconstruction of skull base defects after endoscopic endonasal pituitary surgery. However, the denuded septal cartilage and bone at the donor site usually requires a prolonged period of time for secondary healing, which often causes severe nasal crusting, hyposmia, and possible saddle nose deformity. In this study, we used the free middle turbinate mucosa grafting for repairing mucosa defect of the donor site to see whether this method could reduce the nasal morbidity after the surgery.

Materials and Methods: We retrospectively reviewed patients with pituitary lesions who underwent nasoseptal flap harvesting in endoscopic endonasal pituitary surgery from August 2015 to August 2016. In all cases, the nasoseptal flap was harvested for reconstructing the dural defect and the middle turbinate mucosa was harvested as a free mucosal graft placing on the denuded nasal septum. Septal mucosalization and crusting and olfaction test were evaluated at follow-up appointments.

Results: The 11 enrolled patients were on average 54 years old. There were two males and nine females. Seven cases were pituitary tumor and four cases were Rathke's cleft cyst. All patients underwent nasoseptal flap harvesting for reconstruction of skull base defect and received middle turbinate mucosa grafting on the donor site of the septal cartilage. No CSF leakage was found in all cases. The average duration of complete mucosalization of denuded septal cartilage with middle turbinate graft was 38 day. Nasal crusting was mild or nearly absent and olfaction was almost recovered at postoperative month 3. There were no patients suffered from saddle nose deformity.

Conclusion: Free middle turbinate mucosal grafting is a promising technique for enhancing mucosalization, reducing crusting of nasal septal donor site, and preventing olfactory loss after harvesting nasoseptal flap in endoscopic endonasal pituitary surgery.