Middle turbinate flap for skull base reconstruction: cadaveric feasibility study

Area of Science:

• Neurosurgery
• Otolaryngology
• Surgical Anatomy

Background:

• Endonasal resection of intradural tumors creates defects connecting the subarachnoid space and sinonasal tract.
• Reconstruction with vascularized tissue is the gold standard for these defects.

Purpose of the Study:

• To describe a novel vascularized pedicled flap from the middle turbinate (MT) mucosa.
• To assess the feasibility of this MT flap for reconstructing dural defects in a cadaveric model.

Main Methods:

• Twelve MT flaps were raised in six fresh cadavers.
• Flap vascular supply was identified from the turbinate mucoperiosteum.
• Flap dimensions and coverage of sellar, planum sphenoidale, and fovea ethmoidalis defects were evaluated.

Main Results:

• All MT flaps adequately covered defects of the planum and fovea ethmoidalis.
• Two of twelve flaps were unsuitable for sellar defects, correlating with lengths less than 4.0 cm.
• Mean flap surface area was 5.6 cm², not directly correlating with sellar defect coverage.

Conclusions:

• Harvesting a vascularized MT flap is feasible but technically demanding.
• The MT flap is a viable alternative for reconstructing small defects of the fovea ethmoidalis, planum, and sella.
• This flap is particularly useful when the nasoseptal flap is unavailable and vascularized reconstruction is desired.