J Neurol Surg B Skull Base 2018; 79(S 01): S1-S188
DOI: 10.1055/s-0038-1633722
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

Nasal Floor Reconstruction following Endoscopic Endonasal Surgery Using an Inferiorly Pedicled Nasoseptal Flap

Ian J. Koszewski
1   University of Wisconsin, Madison, Wisconsin, United States
,
Lucas Leonard
1   University of Wisconsin, Madison, Wisconsin, United States
,
Azam Ahmed
1   University of Wisconsin, Madison, Wisconsin, United States
,
Timothy M. McCulloch
1   University of Wisconsin, Madison, Wisconsin, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
02 February 2018 (online)

 

Background Reconstructive options following endoscopic endonasal approaches (EEAs) to the skull base continue to multiply and evolve. While attention has appropriately been paid to safe and effective skull base reconstruction, reconstruction of the nasal corridor remains less studied, and techniques vary widely among institutions. Quality of life outcomes are likely closely tied to nasal reconstruction and command increasing attention. We describe a novel technique of nasal floor reconstruction using a contralateral nasoseptal rotation flap.

Methods Consecutive patients undergoing EEA for resection of ventral skull base lesions were identified via review of an institutional database. Intraoperative videos for those patients in whom the nasal floor was reconstructed using a contralateral mucoperiosteal rotation flap were reviewed. Photodocumentation was captured and supplemented with hand drawn illustrations.

Results Three patients were identified. All required posterior septectomy and unilateral nasoseptal flap harvest for skull base reconstruction, leaving significant exposed bone after surgical approach. Nasal floor reconstruction was achieved by rotating the posterior extent the contralateral mucoperiosteum over the remnant maxillary crest and onto the exposed bone of the nasal floor. Flaps were sized based on the extent of posterior septectomy required for tumor access and the amount of exposed bone left along the nasal floor. Flaps demonstrated potential for wide customization. Relaxing incisions were made posteriorly at the sphenoid rostrum, superiorly greater than 1 cm from the nasal roof to maintain olfactory mucosa, and anteriorly at the extent of bony septectomy. Flaps were pedicled inferiorly. Exposed bone was reduced significantly following flap inset.

Discussion Postoperative “crusting” is one of the most common and troublesome postoperative sequela following EEAs. It is widely understood that leaving areas of exposed bone contributes to such crusting and, as such, minimizing bony exposure should be a goal of reconstruction. In our series, the use of a contralateral, inferiorly pedicled nasoseptal flap harvested from the posterior septum was successful in covering a variety of nasal floor defects. Using intraoperative photodocumentation and supplementary illustrations, we describe this technique, with emphasis on anatomic considerations, optimal flap harvest in the context of creation of a broader corridor, and considerations for inset and postoperative packing. Appropriate patient selection and limitations of the technique are discussed.

Conclusion The use of a contralateral, inferiorly pedicled nasoseptal flap is successful in reconstructing nasal floor defects following select EEAs and can be considered a viable option in the reconstructive surgeon’s armamentarium.