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J Neurol Surg B Skull Base 2017; 78(02): 201-206
DOI: 10.1055/s-0036-1597086
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique Using a Posterior Septal Free Mucosal Graft

Frederick Yoo
1   Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
,
Edward C. Kuan
1   Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
,
Marvin Bergsneider
2   Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
,
Marilene B. Wang
1   Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

13 April 2016

14 October 2016

Publication Date:
09 December 2016 (online)

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Abstract

Objectives The nasoseptal flap (NSF) has become the workhorse for reconstruction in endoscopic endonasal skull-base surgery. The NSF, though useful in reconstruction, may lead to significant donor site morbidity. Published techniques to reduce the donor site morbidity, free mucosal grafts, and septal rotational flaps have shown to reduce crusting and remucosalization times. We present a novel technique utilizing posterior septal mucosa as a free mucosal graft for reconstruction of the anterior septal donor site. The septal mucosal graft is taken from the mucosa overlying the posterior septectomy site of the endonasal approach to skull base tumors.

Design Retrospective chart review.

Setting Single tertiary academic medical center.

Participants All patients who underwent endoscopic endonasal skull-base surgery between November 1, 2014 and August 30, 2015 with free mucosal graft reconstruction of the NSF donor site.

Main Outcome Measures Postoperative graft success.

Results Fifteen patients underwent septal reconstruction using a septal free mucosal graft. There was a 100% graft success rate with near complete remucosalization by 6 weeks postoperatively.

Conclusions The posterior septal free mucosal graft is a simple, reliable method for reconstructing the NSF donor site. The advantages of this technique include utilization of native septal mucosal tissue and middle turbinate preservation.

Keywords

skull base/surgery - skull base/pathology - nasal septum/surgery - nasal cavity/surgery - nasal mucosa/transplantation

Note

This paper was presented as a podium presentation at the North American Skull Base Society Meeting in Scottsdale, AZ on February 12–14, 2016.


 

  • References

  • 1 Zuniga MG, Turner JH, Chandra RK. Updates in anterior skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (1) 75-82
    CrossrefPubMedGoogle Scholar
  • 2 Chin D, Harvey RJ. Endoscopic reconstruction of frontal, cribiform and ethmoid skull base defects. Adv Otorhinolaryngol 2013; 74: 104-118
    PubMedGoogle Scholar
  • 3 Patel MR, Stadler ME, Snyderman CH , et al. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base 2010; 20 (6) 397-404
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Eloy JA, Patel SK, Shukla PA, Smith ML, Choudhry OJ, Liu JK. Triple-layer reconstruction technique for large cribriform defects after endoscopic endonasal resection of anterior skull base tumors. Int Forum Allergy Rhinol 2013; 3 (3) 204-211
    CrossrefPubMedGoogle Scholar
  • 5 Clavenna MJ, Turner JH, Chandra RK. Pedicled flaps in endoscopic skull base reconstruction: review of current techniques. Curr Opin Otolaryngol Head Neck Surg 2015; 23 (1) 71-77
    CrossrefPubMedGoogle Scholar
  • 6 Hadad G, Bassagasteguy L, Carrau RL , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedGoogle Scholar
  • 7 Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 2012; 122 (2) 452-459
    CrossrefPubMedGoogle Scholar
  • 8 Kassam AB, Thomas A, Carrau RL , et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (1) (Suppl. 01) ONS44-ONS52 , discussion ONS52–ONS53
    CrossrefPubMedGoogle Scholar
  • 9 Soudry E, Psaltis AJ, Lee KH, Vaezafshar R, Nayak JV, Hwang PH. Complications associated with the pedicled nasoseptal flap for skull base reconstruction. Laryngoscope 2015; 125 (1) 80-85
    CrossrefPubMedGoogle Scholar
  • 10 Hanson M, Patel PM, Betz C, Olson S, Panizza B, Wallwork B. Sinonasal outcomes following endoscopic anterior skull base surgery with nasoseptal flap reconstruction: a prospective study. J Laryngol Otol 2015; 129 (Suppl. 03) S41-S46
    CrossrefPubMedGoogle Scholar
  • 11 Pant H, Bhatki AM, Snyderman CH , et al. Quality of life following endonasal skull base surgery. Skull Base 2010; 20 (1) 35-40
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Thompson CF, Suh JD, Liu Y, Bergsneider M, Wang MB. Modifications to the endoscopic approach for anterior skull base lesions improve postoperative sinonasal symptoms. J Neurol Surg B Skull Base 2014; 75 (1) 65-72
    PubMedGoogle Scholar
  • 13 de Almeida JR, Snyderman CH, Gardner PA, Carrau RL, Vescan AD. Nasal morbidity following endoscopic skull base surgery: a prospective cohort study. Head Neck 2011; 33 (4) 547-551
    CrossrefPubMedGoogle Scholar
  • 14 Balaker AE, Bergsneider M, Martin NA, Wang MB. Evolution of sinonasal symptoms following endoscopic anterior skull base surgery. Skull Base 2010; 20 (4) 245-251
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Kimple AJ, Leight WD, Wheless SA, Zanation AM. Reducing nasal morbidity after skull base reconstruction with the nasoseptal flap: free middle turbinate mucosal grafts. Laryngoscope 2012; 122 (9) 1920-1924
    CrossrefPubMedGoogle Scholar
  • 16 Kasemsiri P, Carrau RL, Otto BA , et al. Reconstruction of the pedicled nasoseptal flap donor site with a contralateral reverse rotation flap: technical modifications and outcomes. Laryngoscope 2013; 123 (11) 2601-2604
    CrossrefPubMedGoogle Scholar
  • 17 Awad AJ, Mohyeldin A, El-Sayed IH, Aghi MK. Sinonasal morbidity following endoscopic endonasal skull base surgery. Clin Neurol Neurosurg 2015; 130: 162-167
    CrossrefPubMedGoogle Scholar
  • 18 McCoul ED, Anand VK, Bedrosian JC, Schwartz TH. Endoscopic skull base surgery and its impact on sinonasal-related quality of life. Int Forum Allergy Rhinol 2012; 2 (2) 174-181
    CrossrefPubMedGoogle Scholar
  • 19 Harrow BR, Batra PS. Sinonasal quality of life outcomes after minimally invasive resection of sinonasal and skull-base tumors. Int Forum Allergy Rhinol 2013; 3 (12) 1013-1020
    CrossrefPubMedGoogle Scholar
  • 20 Alobid I, Enseñat J, Mariño-Sánchez F , et al. Expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors has a negative impact on sinonasal symptoms and quality of life. Am J Rhinol Allergy 2013; 27 (5) 426-431
    CrossrefPubMedGoogle Scholar
  • 21 Rivera-Serrano CM, Snyderman CH, Gardner P , et al. Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 2011; 121 (5) 990-993
    CrossrefPubMedGoogle Scholar
  • 22 Rawal RB, Kimple AJ, Dugar DR, Zanation AM. Minimizing morbidity in endoscopic pituitary surgery: outcomes of the novel nasoseptal rescue flap technique. Otolaryngol Head Neck Surg 2012; 147 (3) 434-437
    CrossrefPubMedGoogle Scholar
  • 23 Guthikonda B, Nourbakhsh A, Notarianni C, Vannemreddy P, Nanda A. Middle turbinectomy for exposure in endoscopic endonasal transsphenoidal surgery: when is it necessary?. Laryngoscope 2010; 120 (12) 2360-2366
    CrossrefPubMedGoogle Scholar
  • 24 Nyquist GG, Anand VK, Brown S, Singh A, Tabaee A, Schwartz TH. Middle turbinate preservation in endoscopic transsphenoidal surgery of the anterior skull base. Skull Base 2010; 20 (5) 343-347
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Tsakiropoulou E, Vital V, Constantinidis J, Kekes G. Nasal air-conditioning after partial turbinectomy: myths versus facts. Am J Rhinol Allergy 2015; 29 (2) e59-e62
    CrossrefPubMedGoogle Scholar
  • 26 Cassano M, Cassano P. Epistaxis after partial middle turbinectomy: the role of sphenopalatine artery ligation. Am J Otolaryngol 2012; 33 (1) 116-120
    CrossrefPubMedGoogle Scholar