Pedicle Flaps Based on the Sphenopalatine Artery: Anatomical and Surgical Study

Abstract

IntroductionLocal pedicle flaps based on the sphenopalatine artery make it possible to reconstruct large defects of the skull base (SB). Material and methodsFrom January 2008 to January 2013, 64 lesions with involvement of SB were analysed. These lesions were treated using endoscopic endonasal approach and required a pedicle flap based on the sphenopalatine artery. In addition, measurements and flexibility of the flaps were examined in 4 cadaveric nasal cavities. ResultsSurgical group. Sixty-four nasoseptal flaps (NSF) were used, in 4 cases associated with a middle turbinate flap (MTF), and in 1 case supplemented with an inferior turbinate flap (ITF). Five cerebrospinal fluid fistulas (8%) were noted. Among patients with initial lesions, 7% presented an anosmia. Cadaveric group. The length of the NSF varied between 5.2cm and 7.7cm and the width ranged from 3cm to 4.5cm. The ITF provided an anterior–posterior distance between 4.2cm and 5cm, with a width between 1.2cm and 2.8cm. The mean length of MTFs varied between 3.5cm and 4.2cm, with a width between 1.4cm and 1.9cm. ConclusionThe most versatile local flap for the reconstruction of skull base defects is the NSF, and flaps pedicled to the posterolateral nasal artery offer an excellent alternative.