Objective The ability to reconstruct large cranial base defects has greatly improved with the
development of pedicled vascularized flaps. The temporoparietal fascia flap (TPFF)
is a viable alternative to the Hadad-Bassagasteguy nasoseptal flap for large ventral
skull base defects. This study aims to characterize the size of the flap necessary
for optimal ventral skull base reconstruction.
Method A total of 11 formaldehyde-fixed cadaveric heads were used in this study. A TPFF
of varying height and width was harvested on each side (22 total), and passed through
the pterygomaxillary fissure to the ventral skull base to assess its coverage. The
TPFF for a subgroup of 12 sides (six cadaveric heads) was then trimmed to determine
the minimum height necessary for coverage.
Results The range of the TPFF height was 12.5 to 16.5 cm (mean: 14.72 cm). The mean width
of the TPFF was 8.43 cm (SD: 1.01 cm). The mean distance from the TPFF pedicle through
the pterygomaxillary fissure was 5.8 cm (SD: 0.50 cm). All TPFF flaps provided complete
coverage of clival defects, and when rotated anteriorly provided coverage up to the
cribriform plate. The subgroup analysis determined that the minimum height necessary
for complete coverage of cribriform defects and ventral defects up to the planum sphenoidale
was 12 cm (p < 0.01).
Conclusion The TPFF is a versatile alternative to the nasoseptal flap. A TPFF with a height
of at least 12 cm should provide enough coverage for all ventral skull base defects.
