Superiorly Based Middle Turbinate Flap for Anterior Cranial Base Reconstruction: A Cadaveric Feasibility Study and Case Series

 

Objectives: Cerebrospinal fluid (CSF) leaks of the anterior cranial base are frequently repaired with an endonasal, multilayered reconstruction technique utilizing a mucosal onlay graft as part of the repair. Vascularized tissue flaps are superior to free mucosal grafts and biomaterials. Limitations of previously described vascularized flaps include reach and rotation, pedicle availability, and postoperative sinonasal morbidity. The objective of this study is to describe a novel vascularized mucosal reconstruction option utilizing a superiorly based middle turbinate flap and to present a case series demonstrating the utility of this flap.

Design: Cadaveric feasibility study with a technical description and illustrative case series.

Setting: Tertiary academic medical center.

Participants: Three silicone-injected cadaveric specimens (six sides) and seven patients with defects of the anterior cranial fossa and CSF rhinorrhea repaired with a superiorly based middle turbinate flap.

Outcome Measures: Cadaveric feasibility, in vivo repair failure, sinonasal symptoms, and postoperative healing.

Results: Cadaveric dissection demonstrated a consistent vascular plexus arising from the anterior and posterior ethmoid arteries, originating at the superior attachment of the middle turbinate and traveling inferiorly, supplying the mucosa of the middle turbinate ([Fig. 1]). In the clinical series, there were no instances of repair failure. All cases showed rapid and complete remucosalization without significant sinonasal morbidity.

Conclusion: The superiorly based middle turbinate flap is a reliable, versatile, and effective option for a vascularized mucosal flap onlay that can be used in anterior skull base reconstruction. This flap is particularly useful in the repair of defects of the cribriform plate and fovea ethmoidalis.

Publication History

Article published online:
15 February 2022

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