Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;74(Suppl 2):1344-1347.
doi: 10.1007/s12070-021-02490-3. Epub 2021 Mar 6.

Graft-Extended Nasoseptal Flap for Endoscopic Anterior Skull Base Reconstruction: A Novel Technique

Saud Alromaih  1 , Faris Yaghmoor  2 , Ibrahim Alarifi  3 , Saad Alsaleh  1 , Ahmad Alroqi  1 , Mohammad Aloulah  1 , Abdulaziz Almusa  2 , Abdulrazag Ajlan  4 , Ibrahim Sumaily  5
Affiliations

Graft-Extended Nasoseptal Flap for Endoscopic Anterior Skull Base Reconstruction: A Novel Technique

Saud Alromaih et al. Indian J Otolaryngol Head Neck Surg. 2022 Oct.

Abstract

Reconstruction of the anterior part of the anterior skull base with a nasoseptal flap (NSF) is technically demanding. This challenge is mainly related to the real possible length of the flap. Herein, we describe a new technique for extending the NSF such that it can sufficiently cover the far anterior part of the anterior skull base. Three cadaveric heads were used for mucosal graft extension of the NSF. The graft was harvested from the other side, sutured to the NSF, then repositioned over the skull base after opening all the paranasal sinuses. Each head was operated by a rhinologist and a skull base surgeon. The study variables were the initial length of the NSF, the length of the graft harvested, the new length of the graft-extended NSF, and the length of the new graft-extended NSF from the nasal spine. The average length of the NSFs was 6.4 cm (± 0.2); that of the harvested grafts was 2.93 cm (± 0.1); that of the graft-extended NSF was 9.33 cm (± 0.4); and that of the graft-extended NSF from the nasal spine was 3.93 cm. The graft-extended NSF is an easy and extremely useful technique for the reconstruction of the far anterior parts of the skull base. However, further prospective studies on the clinical usefulness of this technique and its long-term results are yet to be performed. Level of evidence: IV.

Keywords: Flap extension; Mucosal graft; Nasoseptal flap; Skull base reconstruction.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestNone declared.

Figures

Fig. 1
Fig. 1
Illustration of the technique. a Incision for the NSF. b Mucosal graft obtained from the other side of the nasal cavity. c Mucosal graft is sutured to the caudal part of the NSF. d The NSF is elevated. e NSF + graft applied in the nasopharynx. f Preparing the defect site. g Placement of the flap + graft over the defect site. NSF nasoseptal flap
Fig. 2
Fig. 2
The graft-extended NSF. a The graft donor site from the other side of the nasal floor. b Suturing the harvested graft to the NSF. c The graft sutured to the flap. d Added length of the flap by the graft. e The graft-extended NSF reaching the uppermost part of the frontal sinus posterior table without any tension. NSF nasoseptal flap
See this image and copyright information in PMC

References

    1. Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116:1882–1886. doi: 10.1097/01.mlg.0000234933.37779.e4. - DOI - PubMed
    1. Castelnuovo P, Ferreli F, Khodaei I, Palma P. Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial PlastSurg. 2011;13(6):411–414. doi: 10.1001/archfacial.2011.44. - DOI - PubMed
    1. Hadad G, Rivero-Serrano CM, Bassagaisteguy LH, et al. Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope. 2011;121:1606–1610. doi: 10.1002/lary.21889. - DOI - PubMed
    1. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus. 2005;19:E4. - PubMed
    1. Kassam A, Gardner P, Snyderman CH, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus. 2005;19:E6. doi: 10.3171/foc.2005.19.1.7. - DOI - PubMed

LinkOut - more resources