Middle turbinate flap for skull base reconstruction: Cadaveric feasibility study

Abstract

Surgical resection of intradural pathology through an endonasal corridor creates defects that communicate the subarachnoid space with the sinonasal tract. Reconstruction of these defects with vascularized tissue is superior to any other method. The purpose of this study is to describe a novel vascularized pedicled flap from the middle turbinate (MT) mucosa and to assess its feasibility using a cadaveric model. Twelve middle turbinate flaps (MTFs) were raised in six fresh cadaveric heads previously injected with colored silicone. Arteries supplying the MT were identified as the turbinate mucoperiosteum was harvested from both its medial and lateral aspects. Length and surface area of the flaps, as well as their ability to cover dural defects of the sella, planum sphenoidale, and fovea ethmoidalis reach were noted. All MTFs adequately covered defects of the planum and fovea ethmoidalis; however, two of the twelve MTFs were not suitable to cover a sellar defect. The mean surface area of the MTFs was 5.6 cm(2). As an independent factor surface area did not correlate with the ability of the flap to cover the sellar defects. However, those flaps that were not suitable for sellar repair were less than 4.0 cm in length. Harvesting of a vascular pedicle flap from the MT is feasible, albeit technically demanding. It should be considered as an alternative for the reconstruction of small defects of the fovea ethmoidalis, planum, and sella, particularly for patients for whom a reconstruction with vascularized tissue is desirable but the nasoseptal flap is not available.