Middle turbinate vascularized flap for skull base reconstruction after an expanded endonasal approach

Abstract

The expanded endonasal approaches to the skull base are modular approaches that arise from the sphenoidal sinus. The reconstructive techniques in these approaches are key to avoid postoperative complications. Available flaps for reconstruction include the pedicled nasoseptal flap, the transpterygoid temporoparietal fascia flap, and the posterior pedicle inferior turbinate flap (PPITF), among others. Recently, the middle turbinate flap has been described in a cadaveric study. We report our preliminary experience in the use of this middle turbinate vascularized flap for skull base reconstruction after expanded endonasal approaches. Ten patients underwent reconstructive procedures with the mucoperiostial vascularized middle turbinate flap. Capability to cover the defect, closure success, operative time and complications related to the procedure are retrospectively analyzed. A satisfactory closure was obtained in all procedures, and there were no complications related to the technique. Required operative time was similar to the time employed for the nasoseptal flap. The vascularized middle turbinate flap is a reliable reconstructive technique for the reconstruction of moderate-sized skull base defects. It can be considered either as the first choice of closure or as an alternative to the nasoseptal flap when this is not available. Different flap combinations may facilitate skull base defect reconstruction.