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Russo F, Valentini M, Czaczkes C, Sileo G, Battaglia P, Turri-Zanoni M, Karligkiotis A, Castelnuovo P. Pedicled nasal flaps in transnasal endoscopic surgery: review of indications and surgical techniques. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:297-309. [PMID: 37224174 PMCID: PMC10551732 DOI: 10.14639/0392-100x-n2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/12/2023] [Indexed: 05/26/2023]
Abstract
At present an exclusive endoscopic endonasal approach is sufficient in the majority of cases to treat pathologies involving the sinonasal compartment and the surrounding anatomical subsites (e.g. orbit, ventral skull base, upper parapharyngeal space, etc.) with the advantage of minimising surgical invasiveness. In this context, nasal vascularised local flaps are widely employed because they represent a more effective option for reconstruction or preservation of noble/vital structures compared to grafts. On the other hand, the surgical extension and morbidity are minimised compared to regional or free flaps. Several nasal local flaps have been described in the literature: the aim of this review is to examine their applications, characteristics, indications, success rates and morbidities. Different nasal flaps based on single or multiple pedicles have been described; the choice between them is based on different factors such as the flap’s shape and dimension, localisation of the pedicle’s origin, width of rotation angle, previous surgeries which could compromise vascularisation, and surgical experience, in addition to the position and dimension of the area which must be resurfaced.
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Affiliation(s)
- Federico Russo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- UPLOAD (Upper and Lower Airways inflammatory Diseases) Research Center, University of Insubria, Varese, Italy
| | - Marco Valentini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Camilla Czaczkes
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Gonzalias-Duque C, Ordoñez R, Montaño LF, Plazola-Hernandez S. Reconstruction of Anophthalmic Sockets With Pedicled Nasoseptal Flap. Ophthalmic Plast Reconstr Surg 2023; 39:492-497. [PMID: 36972120 DOI: 10.1097/iop.0000000000002378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE Patients who undergo eye removal often present with orbital soft-tissue insufficiency and contraction of the eye sockets. The most commonly used reconstruction strategy is grafting the orbit with free grafts, which is associated with the drawback of harvesting tissue from an unconnected site. This study describes the use of the vascularized nasoseptal flap in the reconstruction and enlargement of the contracted anophthalmic cavity in patients with severe or recurrent contracted eye sockets and evaluates its efficacy. METHODS A sphenopalatine-pedicled flap from the nasal septum was harvested and mobilized into the anophthalmic orbit for the reconstruction, coverage, and enlargement of the socket in 17 patients with anophthalmic socket syndrome. Data regarding the demographics, preoperative status, postoperative findings, follow-up, outcomes, dates of mutilant and reconstructive surgery, and relevant clinical or imaging were collected. RESULTS Krishna´s classification was used to assess the postoperative outcomes. The final rating improved in all patients at a median follow-up duration of 35 months. A greater impact was observed in patients who underwent reconstructive surgery before nasoseptal flap creation. Two minor complications occurred; however, major surgical intervention was not required. Implant extrusion was observed in 2 patients. CONCLUSIONS The novel strategy of applying nasoseptal flaps in the reconstruction of anophthalmic sockets results in improved socket grading and a low rate of recurrence (socket contracture or implant extrusion), and complications. The vascular nature of the flap makes it suitable for use in complex cases.
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Affiliation(s)
- Catherinne Gonzalias-Duque
- Servicio de Oculoplástica, Departamento de Oftalmología, Centro Médico Nacional "20 de Noviembre," Mexico
- División de Estudios de Posgrado, Facultad de Medicina, Universidad Autónoma de México, Mexico
| | - Rafael Ordoñez
- División de Estudios de Posgrado, Facultad de Medicina, Universidad Autónoma de México, Mexico
- Departamento de Otorrinolaringologia, Centro Médico Nacional "20 de Noviembre," Mexico
| | - Luis F Montaño
- Laboratorio Inmunobiología, Departamento de Biología Celular y Tisular, Facultad de Medicina, UNAM, Mexico
| | - Sara Plazola-Hernandez
- Servicio de Oculoplástica, Departamento de Oftalmología, Centro Médico Nacional "20 de Noviembre," Mexico
- División de Estudios de Posgrado, Facultad de Medicina, Universidad Autónoma de México, Mexico
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Badaoui JN, Choby G, McMillan RA, Goates AJ, Cofer SA. Triple Layer Oronasal Fistula Repair Using Local Endonasal Flaps: Case Series of Three Patients. Cleft Palate Craniofac J 2023; 60:359-366. [PMID: 35244480 DOI: 10.1177/10556656211062040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Oronasal fistula (ONF) is a common complication encountered after palatoplasty. Repair is indicated when symptoms impact speech and swallowing. In spite of the variety of surgical approaches described to repair these defects, recurrence rates remain high. Traditionally, successful closure is said to be achieved in using a double-layered approach due to the three-dimensional aspect of the defect. The extent of the fistula into the nasal cavity has incited an increased curiosity in using local endonasal flaps. In recent years, endonasal reconstructive procedures have seen increased interest and application, from cranial base defect repairs to orbital reconstruction and beyond. The nasoseptal (NSF) and inferior turbinate flaps (ITF) possess a robust arterial supply and an exceptional reach with excellent results demonstrated in large defect repair. However, the use of these flaps in ONF repair is scarcely discussed in the literature, and their effectiveness is relatively undetermined. In this manuscript, we present a series of three patients who underwent a triple layer ONF closure, with the oral portion incorporating a turn-in mucosal flap plus a local palate rotation flap or greater palatine artery pedicled-rotation flap, and a NSF or an ITF for the nasal portion of the defect.
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Affiliation(s)
- Joseph N Badaoui
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan A McMillan
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J Goates
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Shelagh A Cofer
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
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Lee DH, Lim SC. Mucosal resurfacing of the suprastructure maxillectomy cavity using nasal cavity mucosa flaps. Oral Oncol 2021; 120:105289. [PMID: 33910781 DOI: 10.1016/j.oraloncology.2021.105289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We analyzed clinical data of patients in which the suprastructure maxillectomy site was covered with nasal cavity mucosa flaps with or without free mucosa graft from the nasal septum, to determine the usefulness of this procedure. PATIENTS AND METHODS A total of four edentulous patients who had the suprastructure maxillectomy site covered using nasal cavity mucosa flaps with or without free mucosa graft from the nasal septum between 2014 and 2020, were analyzed. RESULTS All patients underwent suprastructure maxillectomy using the external approach. There were no major complications resulting from surgical intervention. Radiotherapy (RT) was performed in all patients after surgery. All nasal cavity mucosa flaps survived after RT. There was mild cheek retraction, but to a degree that was cosmetically tolerable in all patients. Local recurrence and distant metastasis to the orbit occurred in one patient. Among four patients, two patients died during follow-up, including one tumor related death and one death from old age. CONCLUSION We demonstrated that the use of nasal cavity mucosal flap to cover the suprastructure maxillectomy cavity was effective in improving the patient's quality of life by minimizing wound problems and facial contour changes such as cheek retraction despite postoperative RT.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea.
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Composite Chondromucosal Nasoseptal Flap for Reconstruction of Suprasellar Defects. World Neurosurg 2021; 149:11-14. [PMID: 33556598 DOI: 10.1016/j.wneu.2021.01.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pedicled nasoseptal flap (NSF) is the mainstay for endoscopic skull base reconstruction. We present a novel technique using a semirigid chondromucosal NSF that improves the reinforcement and protection of intracranial structures. METHODS Composite NSFs were performed to repair intraoperative high-flow cerebrospinal fluid leaks in 2 patients who had undergone endoscopic endonasal resection of a suprasellar mass. The surgical technique and postoperative outcomes are described. RESULTS The flaps were sufficient for defect coverage, and the patients did not experience any cerebrospinal fluid leak in the immediate and delayed postoperative periods. No complications related to the composite flap had developed. CONCLUSIONS The composite chondromucosal NSF is a reliable reconstruction option for select ventral cranial base reconstruction cases with the potential to improve the protection of intracranial structures. Additional surgical cases and longer follow-up are required for a better assessment of long-term outcomes.
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Gutierrez WR, Bennion DM, Walsh JE, Owen SR. Vascular pedicled flaps for skull base defect reconstruction. Laryngoscope Investig Otolaryngol 2020; 5:1029-1038. [PMID: 33364390 PMCID: PMC7752068 DOI: 10.1002/lio2.471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. METHODS A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. RESULTS The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a "rescue" nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. CONCLUSION Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Wade R. Gutierrez
- Medical Scientist Training ProgramUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Douglas M. Bennion
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Jarrett E. Walsh
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Scott R. Owen
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Spielman D, Kim M, Overdevest J, Gudis D. The Nasoseptal Chondromucosal Flap: A Rigid Reconstructive Technique for Skull Base and Orbital Defects. ORL J Otorhinolaryngol Relat Spec 2020; 82:268-273. [DOI: 10.1159/000508135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
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Aysel A, Göde S, Midilli R, Karcı HB. Reconstruction of Orbital Walls with Bone Cement in a Maxillectomy Patient. Turk Arch Otorhinolaryngol 2015; 53:183-187. [PMID: 29392004 DOI: 10.5152/tao.2015.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/08/2014] [Indexed: 11/22/2022] Open
Abstract
Orbital wall defects occur because of trauma and secondary to oncologic surgery. Reconstruction of orbital bones is of most importance to ensure normal eye functions and cosmesis. Acrylic resin materials can be used instead of a bone in orbital wall defects that are secondary to the resection of tumors invading the orbita. Polymethyl methacrylate is one of the acrylic resin materials. In this study, the orbital wall reconstruction technique with bone cement after maxillectomy and results are reported.
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Affiliation(s)
- Abdülhalim Aysel
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Sercan Göde
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Raşit Midilli
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - H Bülent Karcı
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
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Abstract
PURPOSE OF REVIEW Skull base surgery has undergone a fundamental transformation with the development and rapid adoption of endoscopic endonasal expanded approaches. Defects created from these newer approaches have necessitated an evolution of novel reconstructive techniques, which are reviewed here. RECENT FINDINGS New reconstructive techniques continue to be developed for repairing surgical defects from endoscopic endonasal skull base resections. Improvisations also allow well known flaps to be used in these approaches. Long term outcomes from repair using some of these techniques are now becoming available. SUMMARY Endoscopic resection of previously unapproachable skull base lesions has become possible with advancements in technology, as well as reconstructive methods. These newer techniques may offer improved outcomes and lower morbidity over conventional surgery.
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Senior BA. International Forum of Allergy & Rhinology. Editorial. Int Forum Allergy Rhinol 2014; 4:523-4. [PMID: 24989461 DOI: 10.1002/alr.21365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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