Modified Nasoseptal Flap Skull Base Reconstruction with Preservation of the Anterior Septal Cartilaginous Mucosal Buttress: Evolution of a Sinonasal Physiologic-Structural Preservation Technique

Beginning in 2007, preservation of the anterior nasal septal cartilaginous buttress during planning of nasoseptal flap skull base reconstruction planning was attempted by preoperative CT measurements of the potential skull base defect with intraoperative verification. Prior to 2017, standard nasoseptal flaps extending to the mucocutaneous columellar junction with reverse cartilage protection flap were routinely performed in 44 cases (44/501) 9%. Beginning in October of 2017, CT measurements were performed to estimate the length of the flap required for skull base reconstruction preoperatively and verified intraoperatively. Forty-four (44/427) 10% of EESS cases required nasoseptal flap skull base reconstructions. Fifteen (3%) procedures required standard NSF due to measurement of the length skull base defect related to the length of the NSF. Twenty-nine (7%) modified NSFs were performed with preservation of the anterior septal cartilaginous buttress without a reverse flap or other methods to preserve the denuded septal cartilage. Anatomic location of the pathology utilizing the modified NSF in the 29 procedures in 6 clival tumors, 7 sellar tumors, 4 lateral tumors, 12 planum tumors. Fifteen standard NSFs were required related to the anatomic location of the pathology and required length of the NSF in 0 clival tumors, 3 sellar tumors, 3 lateral tumors, 9 planum tumors). The length of the modified nasoseptal flap had a median length of 5 cm (4–5.5 cm). There was one partial distal standard NSF failure with CSF leak and no modified NSF failures or CSF leak occurrences. To date, there has been no evidence of saddle nose deformities in our series. Modified nasoseptal flaps with preservation of bilateral mucosal coverage of the anterior septal cartilage can be performed and considered with preoperative measurement planning to preserve the anterior septal cartilage mucosa to maintain sinonasal physiology.

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Artikel online veröffentlicht:
07. Februar 2025