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

Area of Science:

• Neurosurgery
• Otolaryngology
• Plastic Surgery

Background:

• Skull base reconstruction presents significant challenges.
• The nasoseptal flap (NSF) is the primary method but may be inadequate for large or compromised defects.
• Novel reconstructive options are needed for clival and craniovertebral junction (CVJ) defects.

Purpose of the Study:

• To describe a novel nasopharyngo-septal flap for clival and CVJ reconstruction.
• To evaluate its suitability for defects where the NSF is insufficient.

Main Methods:

• A cadaveric study involving endoscopic endonasal dissection in 15 specimens.
• Modification of the inferior incision of the NSF, incorporating nasopharyngeal mucosa.
• Creation of a butterfly-shaped flap designed for postero-superior rotation.

Main Results:

• A novel, inferiorly based, butterfly-shaped nasopharyngo-septal flap was successfully formulated.
• The flap, supplied by ascending pharyngeal arteries, had a mean surface area of 12.35 cm².
• The flap adequately covered the clivus and CVJ in all cadavers.

Conclusions:

• The nasopharyngo-septal flap is a viable vascularized flap for clival and CVJ reconstruction.
• It serves as an effective alternative when the standard NSF is insufficient.
• This flap can also function as a salvage option when the NSF cannot be harvested.