The Nasopharyngo-Septal Butterfly Flap: A Novel Adjunct for Reconstructing Large Skull Base Defects.

IF 1.8 Q2 OTORHINOLARYNGOLOGY OTO Open Pub Date : 2024-10-30 eCollection Date: 2024-10-01 DOI:10.1002/oto2.70016
Moataz D Abouammo, Maithrea S Narayanan, Mohammad B Alsavaf, Mohammed Alwabili, Jaskaran S Gosal, Govind S Bhuskute, Claudio Callejas, Kyle K VanKoevering, Kyle C Wu, Daniel M Prevedello, Ricardo L Carrau
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Abstract

Objective: Skull base defects can be challenging to reconstruct. The nasoseptal flap (NSF) remains the first-line option for reconstruction. However, it can be inadequate to cover wide defects or compromised by tumor invasion or prior surgery requiring additional reconstructive options. The goal of the study is to describe a novel flap for clival and craniovertebral junction (CVJ) reconstruction.

Study design: Cadaveric study with an illustrative clinical case.

Setting: Cadaver dissection laboratory and tertiary university hospital.

Methods: Endoscopic endonasal dissection was performed in 15 cadavers. A modification of the inferior incision of the NSF was carried out. The inferior incision was performed at a more cranial location, sparing the mucosa of the posterior septum. Two lateral longitudinal incisions were carried out at the pterygo-sphenoidal junction freeing the nasopharyngeal mucosa. A third incision was performed separating the rostral mucosa from the nasal floor. The resulting flap was rotated postero-superiorly covering the clivus and CVJ.

Results: An inferiorly based butterfly-shaped nasopharyngo-septal flap, consisting of nasopharyngeal and posterior septal mucosa and receiving blood supply from the bilateral ascending pharyngeal arteries, was formulated. The lower wings comprised nasopharyngeal mucosa while the upper wings comprised posterior septal mucosa. The mean surface area of the flap was 12.35 ± 0.21 cm2 covering the clivus and CVJ in all cadavers.

Conclusion: The nasopharyngo-septal flap is a novel vascularized flap that is well-suited for reconstructing clival and CVJ defects where the NSF is insufficient and can also be used as a salvage flap in cases where the NSF is unobtainable.

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鼻咽部-鼻隔膜蝶形瓣:重建大面积颅底缺损的新辅助手段
目的:颅底缺损的重建具有挑战性。鼻隔瓣(NSF)仍是重建的一线选择。然而,它可能不足以覆盖宽大的缺损,或因肿瘤侵犯或之前的手术而受到影响,需要其他的重建选择。本研究的目的是描述一种用于颅骨和颅椎交界处(CVJ)重建的新型皮瓣:研究设计:尸体研究,附带说明性临床病例:地点:尸体解剖实验室和三级甲等大学医院:方法:在15具尸体上进行了内窥镜鼻腔内解剖。方法:对 15 具尸体进行了内窥镜鼻腔内解剖。下切口位于头颅更高的位置,保留了后鼻中隔的粘膜。在翼鼻交界处做两个侧向纵切口,游离出鼻咽粘膜。第三个切口将喙粘膜与鼻底分离。结果:结果:形成了一个由鼻咽和鼻中隔后部粘膜组成的蝶形鼻咽-鼻中隔皮瓣,由双侧咽升动脉供血。下翼包括鼻咽粘膜,上翼包括后鼻中隔粘膜。皮瓣的平均表面积为 12.35 ± 0.21 平方厘米,覆盖了所有尸体的蒂部和 CVJ:结论:鼻咽喉-鼻中隔皮瓣是一种新型血管化皮瓣,非常适合重建NSF不足的瓣膜和CVJ缺损,也可在无法获得NSF的情况下用作挽救皮瓣。
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来源期刊
OTO Open
OTO Open Medicine-Surgery
CiteScore
2.70
自引率
0.00%
发文量
115
审稿时长
15 weeks
期刊最新文献
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