Lateral nasal wall extension of the nasoseptal flap for skull‐base and medial orbital wall defects

Background Sinonasal and skull‐base tumors that previously required open resection can often be completely resected via an endonasal approach. The nasoseptal flap (NSF) is the workhorse vascularized tissue flap for the endoscopic reconstruction of large skull‐base defects from tumor resections. The...

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Bibliographic Details
Published in:International forum of allergy & rhinology 2019-09, Vol.9 (9), p.1041-1045
Main Authors: McCormick, Justin, Allen, Mark, Kain, Joshua J., Pena‐Garcia, Jaime A, Cho, Do‐Yeon, Riley, Kristen O., Woodworth, Bradford A.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cerebrospinal fluid
cerebrospinal fluid leak
Defects
Edema
Endoscopy
extended nasoseptal flap
Eyelid
Female
Humans
Male
Mucosa
Nasal Septum - surgery
nasoseptal flap
Orbital Diseases - surgery
Reconstructive Surgical Procedures
Rhinoplasty - methods
Skull
Skull Base - surgery
Skull Base Neoplasms - surgery
skull‐base reconstruction
skull‐base repair
skull‐base resection
skull‐base tumor
Surgical Flaps
Treatment Outcome
Tumors
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Summary:Background Sinonasal and skull‐base tumors that previously required open resection can often be completely resected via an endonasal approach. The nasoseptal flap (NSF) is the workhorse vascularized tissue flap for the endoscopic reconstruction of large skull‐base defects from tumor resections. The objective of the current article is to describe a novel modification of the NSF for simultaneous reconstruction of skull‐base and medial orbital wall defects. Methods An extension of the standard NSF to include mucosa of the lateral nasal wall was developed for closure of simultaneous skull‐base and medial orbital wall defects. Outcomes including successful cerebrospinal fluid (CSF) leak closure, orbital edema, and postoperative cosmesis are reported. Eyelid edema was characterized according to the Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) scale. Results Three patients underwent reconstruction using the modified NSF (average age 75 years). The average defect size of the skull base was 3.6 ± 0.1 cm by 2.3 ± 0.2 cm. The average defect size of the medial orbit was 2.7 ± 0.1 cm by 2.6 ± 0.1 cm. All defects were successfully covered intraoperatively using the lateral nasal wall extension of the NSF. Two patients developed mild eyelid edema, whereas 1 individual had no noticeable swelling (SPREE classification 2, 2, and 1). All patients were successfully sealed at last clinical follow up (average 28 weeks). Conclusion The modification of the NSF described here provides excellent coverage for reconstruction of large anterior skull‐base defects and simultaneous medial orbital wall defects.
ISSN:2042-6976
2042-6984
DOI:10.1002/alr.22364