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Can Posterior Septal Nasal Floor Mucosal Flap During Skull Base Reconstruction Repair Cerebrospinal Fluid Leaks?

by Linda Kossoff •

Can use of a posterior septal nasal floor (PSNF) mucosal flap during skull base reconstruction repair cerebrospinal fluid (CSF) leaks with less risk of complication related to local donor site morbidity? 

BOTTOM LINE 

The PSNF flap provides a sizeable pedicled region for reconstruction comparable to other pedicled nasal flaps and appears to produce good postoperative outcomes with reduced donor site morbidity. 

BACKGROUND: Pedicled nasoseptal flaps (NSF) are the current workhorse in skull base reconstruction during endoscopic endonasal approaches (EEAs) to repair CSF leaks with modifications designed to extend the length or pedicle. However, there is a 27% complication rate related to local donor site morbidity, resulting in reduced quality of life (QOL). 

STUDY DESIGN: Cadaveric dissection, radiographic analysis, and retrospective case series. 

SETTING: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn. 

SYNOPSIS: Researchers hypothesized that a nasal floor flap created with a pedicle traveling up the posterior septal wall would produce a pedicled flap similar to the NSF. They transformed the nasal floor free mucosal graft (FMG) harvest site into a pedicled flap, resulting in the pedicled SNF (PedSNF), and then harvested from multiple cadaver specimens. Flap dimensions measured via computed tomography demonstrated that both right and left flaps were feasible for reconstruction. Researchers noted that the flap demonstrated good arc rotation along its pedicle following complete dissection. For the case series, a total of 15 patients underwent reconstruction of sellar and/ or planum defects using the PedSNF technique. A CSF leak was present intraoperatively in eight cases. In all 15 cases, surgeons were able to successfully repair the defect without difficulty. There appeared to be low morbidity associated with nasal floor defect. Authors concluded that the PSNF technique provides a sizable pedicled region and can be applied for the reconstruction of sellar and suprasellar defects in the presence of CSF leaks. Study limitations included limited patient follow-up. 

CITATION: Bowen AJ, Eltahir A, Goates AJ, et al. The posterior septal nasal floor mucosal flap for cranial base reconstruction [published online ahead of print February 28, 2022]. Laryngoscope.