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Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

Published on: December 5, 2025

Pedicled extranasal flaps in skull base reconstruction.

Grace G Kim¹, Anna X Hang, Candace A Mitchell

¹Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, Chapel Hill, NC 27599, USA.

Advances in Oto-Rhino-Laryngology

|December 22, 2012

Summary

Cerebrospinal fluid (CSF) leaks can be repaired using various surgical flaps. The nasoseptal flap (NSF) is preferred for most skull base defects, but alternatives exist when it

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Area of Science:

Neurosurgery
Otolaryngology
Skull Base Surgery

Background:

Cerebrospinal fluid (CSF) leaks often occur after skull base surgery or spontaneously.
Endoscopic endonasal surgery is now preferred for skull base pathology management.
Repair techniques have advanced, offering better outcomes for CSF leak closure.

Purpose of the Study:

To review and describe various reconstructive flaps for skull base defects.
To outline the characteristics and appropriate uses of different surgical flaps.
To provide an updated overview of CSF leak repair options.

Main Methods:

Review of current literature on skull base reconstruction techniques.
Description of different flap types, including free grafts, pedicled vascular flaps, and novel alternatives.

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Analysis of flap characteristics, coverage areas, and success rates.

Main Results:

Small defects (<1 cm) are typically repaired with multilayered free grafts.
Large defects (>3 cm) benefit from pedicled vascular flaps, notably the nasoseptal flap (NSF), which offers high success rates.
When NSF is unavailable, options include intranasal flaps (inferior/middle turbinate) and regional flaps (pericranial, temporoparietal fascial, palatal), alongside newer options like the facial buccinator and occipital galeopericranial flaps.

Conclusions:

The nasoseptal flap (NSF) is the primary choice for most skull base reconstructions due to its efficacy.
A range of alternative flaps are available for situations where the NSF cannot be used.
Successful management of cerebrospinal fluid leaks relies on careful selection and preoperative planning of reconstructive flaps.