Abstract
Introduction
Over the past several decades expanded endonasal approaches have advanced significantly,
paralleling the increasing importance of skull base defect reconstruction. The nasoseptal
flap (NSF) is first line for most skull base reconstruction but may fail for complex
or recurrent cerebrospinal fluid (CSF) leaks in central skull base. The inferior turbinate
flap (ITF) presents an alternative due to proximity and robust vascular supply. This
cadaveric study compares the NSF and ITF in central skull base repairs, detailing
indications, limitations, and dimensions.
Methods
We analyzed five cadaveric head specimens provided by the Medical College of Georgia
Department of Anatomy. The NSF and ITF were raised bilaterally on each head, yielding
20 flaps in total. Length and width of each flap were measured, and total coverage
area was calculated. SPSS (ver.20.0) was used for statistical analysis. Differences
in mean width, length, and coverage area between the NSF and ITF were analyzed using
Student's two-independent sample t-test, with p-values <0.05 considered statistically significant.
Results
The NSF was significantly longer (64.6 mm) than ITF (42.8 mm), but the ITF was wider
(46.6 mm) than NSF (36.5 mm). NSF had a larger mean coverage area (23.6 cm2) than ITF (19.9 cm2) (p = 0.053).
Conclusion
While the NSF provides superior coverage, the ITF is a viable option in the reconstruction
ladder for central skull base defects when NSF fails, offering advantages in terms
of proximity, vascular supply, and lower morbidity over other rescue flaps. Surgical
technique in harvesting this flap should be known to any skull base surgeon over other
more complex reconstruction flaps.
Keywords
skull base reconstruction - nasoseptal - inferior turbinate - flaps - grafts - cerebrospinal
fluid leak
