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Calculating nasoseptal flap dimensions: a cadaveric study using cone beam computed tomography

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

We hypothesize that three-dimensional imaging using cone beam computed tomography (CBCT) is suitable for calculating nasoseptal flap (NSF) dimensions. To evaluate our hypothesis, we compared CBCT NSF dimensions with anatomical dissections. The NSF reach and vascularity were studied. In an anatomical study (n = 10), CBCT NSF length and surface were calculated and compared with anatomical dissections. The NSF position was evaluated by placing the NSF from the anterior sphenoid sinus wall and from the sella along the skull base towards the frontal sinus. To visualize the NSF vascularity in CBCT, the external carotic arteries were perfused with colored Iomeron. Correlations between CBCT NSFs and anatomical dissections were strongly positive (r > 0.70). The CBCT NSF surface was 19.8 cm2 [16.6–22.3] and the left and right CBCT NSF lengths were 78.3 mm [73.2–89.5] and 77.7 mm [72.2–88.4] respectively. Covering of the anterior skull base was possible by positioning the NSF anterior to the sphenoid sinus. If the NSF was positioned from the sella along the skull base towards the frontal sinus, the NSF reached partially into the anterior ethmoidal sinuses. CBCT is a valuable technique for calculating NSF dimensions. CBCT to demonstrate septum vascularity in cadavers proved to be less suitable. The NSF reach for covering the anterior skull base depends on positioning. This study encourages preoperative planning of a customized NSF, in an attempt to spare septal mucosa. In the concept of minimal invasive surgery, accompanied by providing customized care, this can benefit the patients’ postoperative complaints.

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References

  1. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882–1886

    Article  PubMed  Google Scholar 

  2. El-Sayed IH, Roediger FC, Goldberg AN, Parsa AT, McDermott MW (2008) Endoscopic reconstruction of skull base defects with the nasal septal flap. Skull Base 18:385–394

    Article  PubMed Central  PubMed  Google Scholar 

  3. Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63:ONS44–ONS52 (Discussion ONS52–3)

    Article  PubMed  Google Scholar 

  4. Patel MR, Taylor RJ, Hackman TG, Germanwala AV, Sasaki-Adams D, Ewend MG, Zanation AM (2013) Beyond the nasoseptal flap: outcomes and pearls with secondary flaps in endoscopic endonasal skull base reconstruction. Laryngoscope 124:846–852

    Article  Google Scholar 

  5. Pinheiro-Neto CD, Snyderman CH (2013) Nasoseptal flap. Adv Otorhinolaryngol 74:42–55

    PubMed  Google Scholar 

  6. Gagliardi F, Boari N, Mortini P (2011) Reconstruction techniques in skull base surgery. J Craniofac Surg 22:1015–1020

    Article  PubMed  Google Scholar 

  7. Eloy JA, Patel AA, Shukla PA, Choudhry OJ, Liu JK (2013) Early harvesting of the vascularized pedicled nasoseptal flap during endoscopic skull base surgery. Am J Otolaryngol 34:188–194

    Article  PubMed  Google Scholar 

  8. Harvey RJ, Nogueira JF, Schlosser RJ, Patel SJ, Vellutini E, Stamm AC (2009) Closure of large skull base defects after endoscopic transnasal craniotomy. Clin Artic J Neurosurg 111:371–379

    Article  Google Scholar 

  9. Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB (2009) Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 23:518–521

    Article  PubMed  Google Scholar 

  10. Peris-Celda M, Pinheiro-Neto CD, Funaki T, Fernandez-Miranda JC, Gardner P, Snyderman C, Rhoton AL (2013) The extended nasoseptal flap for skull base reconstruction of the clival region: an anatomical and radiological study. J Neurol Surg B Skull Base 74:369–385

    Article  PubMed Central  PubMed  Google Scholar 

  11. Pinheiro-Neto CD, Ramos HF, Peris-Celda M, Fernandez-Miranda JC, Gardner PA, Snyderman CH, Sennes LU (2011) Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction. Laryngoscope 121:2514–2520

    Article  PubMed  Google Scholar 

  12. de Almeida JR, Snyderman CH, Gardner PA, Carrau RL, Vescan AD (2011) Nasal morbidity following endoscopic skull base surgery: a prospective cohort study. Head Neck 33:547–551

    Article  PubMed  Google Scholar 

  13. McCoul ED, Anand VK, Bedrosian JC, Schwartz TH (2012) Endoscopic skull base surgery and its impact on sinonasal-related quality of life. Int Forum Allergy Rhinol 2:174–181

    Article  PubMed  Google Scholar 

  14. Pinheiro-Neto CD, Prevedello DM, Carrau RL, Snyderman CH, Mintz A, Gardner P, Kassam A (2007) Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study. Laryngoscope 117:1560–1569

    Article  PubMed  Google Scholar 

  15. Hashimoto K, Arai Y, Iwai K, Araki M, Kawashima S, Terakado M (2003) A comparison of a new limited cone beam computed tomography machine for dental use with a multidetector row helical CT machine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95:371–377

    Article  PubMed  Google Scholar 

  16. Halazonetis DJ (2005) From 2-dimensional cephalograms to 3-dimensional computed tomography scans. Am J Orthod Dentofacial Orthop 127:627–637

    Article  PubMed  Google Scholar 

  17. Ahmad M, Jenny J, Downie M (2012) Application of cone beam computed tomography in oral and maxillofacial surgery. Aust Dent J 57(Suppl 1):82–94

    Article  PubMed  Google Scholar 

  18. van Vlijmen OJ, Rangel FA, Berge SJ, Bronkhorst EM, Becking AG, Kuijpers-Jagtman AM (2011) Measurements on 3D models of human skulls derived from two different cone beam CT scanners. Clin Oral Investig 15:721–727

    Article  PubMed  Google Scholar 

  19. Fourie Z, Damstra J, Ren Y (2012) Application of cone beam computed tomography in facial imaging science. Shanghai Kou Qiang Yi Xue 21:220–231

    PubMed  Google Scholar 

  20. Fourie Z, Damstra J, Schepers RH, Gerrits PO, Ren Y (2012) Segmentation process significantly influences the accuracy of 3D surface models derived from cone beam computed tomography. Eur J Radiol 81:e524–e530

    Article  PubMed  Google Scholar 

  21. Chiu CS, Clark RK (1991) Reproducibility of natural head position. J Dent 19:130–131

    Article  CAS  PubMed  Google Scholar 

  22. Shah RN, Surowitz JB, Patel MR, Huang BY, Snyderman CH, Carrau RL, Kassam AB, Germanwala AV, Zanation AM (2009) Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 119:1067–1075

    Article  PubMed  Google Scholar 

  23. Rasband WS (1997–2014) ImageJ, U.S. National Institutes of Health, Bethesda, MD. http://imagej.nih.gov/ij/

  24. Cheng F, Yin S, Djamaldine MS, Zhang W (2013) Endoscopic reconstruction skull base using pedicled nasoseptal flap and its anatomy measurement. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 27:741–744

    PubMed  Google Scholar 

  25. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR (2010) Comparison of five cone beam computed tomography systems for the detection of vertical root fractures. J Endod 36:126–129

    Article  PubMed  Google Scholar 

  26. Stratemann SA, Huang JC, Maki K, Miller AJ, Hatcher DC (2008) Comparison of cone beam computed tomography imaging with physical measures. Dentomaxillofac Radiol 37:80–93

    Article  CAS  PubMed  Google Scholar 

  27. Kau CH, Richmond S, Incrapera A, English J, Xia JJ (2007) Three-dimensional surface acquisition systems for the study of facial morphology and their application to maxillofacial surgery. Int J Med Robot 3:97–110

    Article  PubMed  Google Scholar 

  28. Miracle AC, Mukherji SK (2009) Conebeam CT of the head and neck, part 1: physical principles. Am J Neuroradiol 30:1088–1095

    Article  CAS  PubMed  Google Scholar 

  29. Kakeda S, Korogi Y, Miyaguni Y, Moriya J, Ohnari N, Oda N, Nishino K, Miyamoto W (2007) A cone-beam volume CT using a 3D angiography system with a flat panel detector of direct conversion type: usefulness for superselective intra-arterial chemotherapy for head and neck tumors. Am J Neuroradiol 28:1783–1788

    Article  CAS  PubMed  Google Scholar 

  30. Ishikura R, Ando K, Nagami Y, Yamamoto S, Miura K, Pande AR, Yamano T, Hirota S, Nakao N (2006) Evaluation of vascular supply with cone-beam computed tomography during intraarterial chemotherapy for a skull base tumor. Radiat Med 24:384–387

    Article  PubMed  Google Scholar 

  31. Wachsmuth L (2004) Praktische Anatomie. Springer Verlag, Berlin

    Google Scholar 

  32. Harvey RJ, Smith JE, Wise SK, Patel SJ, Frankel BM, Schlosser RJ (2008) Intracranial complications before and after endoscopic skull base reconstruction. Am J Rhinol 22:516–521

    Article  PubMed  Google Scholar 

  33. de Almeida JR, Vescan AD, Gullane PJ, Gentili F, Lee JM, Lohfeld L, Ringash J, Thoma A, Witterick IJ (2012) Development of a disease-specific quality-of-life questionnaire for anterior and central skull base pathology–the skull base inventory. Laryngoscope 122:1933–1942

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Klaas van Linschoten, Peter Veldman and Steve Oosterhoff of the section Anatomy, Ruud Kortekaas of the Department of Neuroscience and Minke van den Berge for help and (statistical) support.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    Ellen ten Dam, Astrid G. W. Korsten-Meijer, Bernard F. A. M. van der Laan & Robert A. Feijen

  2. Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, Groningen, The Netherlands

    Ellen ten Dam

  3. Department of Oral- and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands

    Rutger H. Schepers

  4. Department of Orthodontics, University Medical Center Groningen, Groningen, The Netherlands

    Wicher J. van der Meer

  5. Department of Neuroscience Section Anatomy, University Medical Center Groningen, Groningen, The Netherlands

    Peter O. Gerrits

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  1. Ellen ten Dam
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  2. Astrid G. W. Korsten-Meijer
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  3. Rutger H. Schepers
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  4. Wicher J. van der Meer
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  5. Peter O. Gerrits
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  6. Bernard F. A. M. van der Laan
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Correspondence to Ellen ten Dam.

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ten Dam, E., Korsten-Meijer, A.G.W., Schepers, R.H. et al. Calculating nasoseptal flap dimensions: a cadaveric study using cone beam computed tomography. Eur Arch Otorhinolaryngol 272, 2371–2379 (2015). https://doi.org/10.1007/s00405-014-3353-3

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  • DOI: https://doi.org/10.1007/s00405-014-3353-3

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