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Vinciguerra A, Turri-Zanoni M, Ferrari M, Mattavelli D, Sileo G, Rampinelli V, Abbate V, Verillaud B, Schreiber A, Battaglia P, Bignami M, Nicolai P, Castelnuovo P, Herman P. Nasoseptal flap with extended pedicle dissection based on the maxillary artery: Clinical series of 55 cases. Int Forum Allergy Rhinol 2024. [PMID: 38268100 DOI: 10.1002/alr.23326] [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: 11/16/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
KEY POINTS Nasoseptal flap with extended pedicle dissection is a low morbidity and high success rate flap. It is a flap that can be applied to reconstruct a wide range of ipsilateral skull base defects.
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Affiliation(s)
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Lariana, Como, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giorgio Sileo
- Division of Otolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Benjamin Verillaud
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Alberto Schreiber
- Unit of Otorhinolaryngology Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Lariana, Como, Italy
| | - Maurizio Bignami
- Division of Otolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Paolo Castelnuovo
- Division of Otolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
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Jeong CY, Cho JH, Park YJ, Kim SW, Park JS, Abdullah Basurrah M, Kim DH, Kim SW. Differences in the predicted nasoseptal flap length among races: A propensity score matching analysis. PLoS One 2023; 18:e0283140. [PMID: 36928861 PMCID: PMC10019619 DOI: 10.1371/journal.pone.0283140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES We compared the lengths of a nasoseptal flap (NSF) and skull base according to race, age, and sex. METHODS We performed paranasal sinus computed tomography in 19,961 adult patients between 2003 and 2022. The race of the patients was East Asian (n = 71), Caucasian (n = 71), or Middle Eastern (n = 71). The expected lengths of the NSF and anterior skull base defect were measured and analyzed according to race, age, and sex. RESULTS Compared with Caucasians and Middle Easterners, East Asians had a shorter NSF length (p < 0.001) and lower ratio of the expected NSF length to the expected defect length (p < 0.001). There was no difference in the values among age groups. The expected NSF length was longer, and the ratio of the expected NSF length to the expected defect length was higher, in males than females (p < 0.001 for both). CONCLUSIONS East Asians and females had a shorter NSF length and lower ratio of expected NSF to surgical defect lengths after anterior skull base reconstruction compared with the other races and with males, respectively. Anatomical differences should be considered when long NSF lengths are required, such as for anterior skull base reconstruction.
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Affiliation(s)
- Chang Yeong Jeong
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Jin Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Pneumatization of the Sphenoidal Sinus May Affect Endonasal Cranial Base Reconstruction. J Craniofac Surg 2022; 33:e808-e810. [DOI: 10.1097/scs.0000000000008690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/05/2022] Open
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Elhassan HA, Zocchi J, Adegboyega G, Lambertoni A, Bozkurt G, Karligkiotis A, Turri-Zanoni M, Battaglia P, Bignami M, Castelnuovo P. Anterior ethmoid artery septal flap for endoscopic reconstruction of frontal sinus cerebrospinal fluid leak. Clin Otolaryngol 2021; 46:1119-1122. [PMID: 33813802 DOI: 10.1111/coa.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jacopo Zocchi
- Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Gideon Adegboyega
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Alessia Lambertoni
- Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Gülpembe Bozkurt
- Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | | | - Mario Turri-Zanoni
- Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Paolo Battaglia
- Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Maurizio Bignami
- Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Paolo Castelnuovo
- Barts and The London School of Medicine, Queen Mary University of London, London, UK
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Sung KS, Lim J, Na M, Lee S, Kim JS, Hong JB, Hong CK, Moon JH. Anterior skull base reconstruction using nasoseptal flap: cadaveric feasibility study and clinical implication [SevEN-001]. J Otolaryngol Head Neck Surg 2020; 49:67. [PMID: 32958073 PMCID: PMC7504836 DOI: 10.1186/s40463-020-00460-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pedicled nasoseptal flap (PNSF) has significantly improved the surgical outcomes of endoscopic endonasal approach (EEAs) by reducing cerebrospinal fluid (CSF) leakage. The purpose of this study is to assess the feasibility of using a PNSF for anterior skull base (ASB) reconstruction and to describe a method to compensate for a short flap based on our results. METHODS In this cadaveric study, ASB dissection without sphenoidotomy was performed using 10 formalin-fixed and 5 fresh adult cadaver specimens, and the sufficiency of the PNSF to cover the ASB was assessed. After the sphenoidotomy, the length by which the PNSF fell short in providing coverage at the posterior wall of the frontal sinus (CPFS), and the extent of the anterior coverage from the limbus (CL) of the sphenoid bone was measured. RESULTS Without sphenoidotomy, the mean length of the remaining PNSF after the coverage of the posterior wall of the frontal sinus was 0.67 cm. After sphenoidotomy, the PNSF fell short by a mean length of 2.10 cm, in providing CPFS. The CL was 1.86 cm. Based on these findings, defects resulting from an endoscopic resection of ASB tumors were reconstructed using PNSF without total sphenoidotomy in 3 patients. There were no postoperative CSF leaks or complications. CONCLUSIONS The use of PNSF for ASB reconstruction may be insufficient to cover the entire ASB defect after removal of large lesions which need total sphenoidotomy. When possible, by leaving some portion of the anterior sphenoid wall for supporting the PNSF, successful ASB reconstruction could be achieved in endoscopic resection of ASB tumors. Additional methods might be needed in some cases of large ASB lesions wherein the anterior sphenoid wall should be removed totally and the ASB defect is too large.
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Affiliation(s)
- Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jaejoon Lim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Minkyun Na
- Department of Neurosurgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sanghun Lee
- Department of Neurosurgery, Cheonan Chungmu Hospital, Cheonan, Republic of Korea
| | - Ju-Seong Kim
- Department of Neurosurgery, Ewha Womans Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
- , 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03772, Republic of Korea.
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Bartier S, Verillaud B, Guichard JP, Kania R, Camous D, Herman P. Anatomo-radiological study supporting the use of ipsilateral nasoseptal flap for the transpterygoid management of temporo-sphenoidal meningoceles. A review of 21 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:37-42. [PMID: 31631054 DOI: 10.1016/j.anorl.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Surgical treatment of temporo-sphenoidal meningoceles involves the reduction of the meningocele, watertight closure and defect coverage with a nasoseptal flap (NSF). It can be performed contralaterally or ipsilaterally: in the latter situation, the pedicle of the flap must be dissected into the pterygopalatine fossa. The objective of this study was to evaluate the benefit of using an ipsilateral NSF in transpterygoid approaches for the management of temporo-sphenoidal meningoceles, compared to a contralateral NSF, based on a radiological study. MATERIAL AND METHODS Retrospective monocentric study of 21 cases, between 2002 and 2018. Measurement of the NSF lengths, and lengths needed to cover the defect were evaluated on the preoperative scanner. Early and later failure and complication rates were evaluated. RESULTS Seventeen cases of temporo-sphenoidal meningoceles with available CT scan were identified. The mean duration of follow up was 27.9 months [1-147]. Theoretical lengths of the ipsi and contralateral NSF were comparable: 71.4±7.8mm vs. 78.8±8mm, P=0.729. In 8 cases/18 (42%), the theoretical length of the contralateral NSF was not long enough to cover the defect beyond the V2 (mean lack of 8.87±6.6mm). In all cases, the theoretical length of the ipsilateral NSF was sufficient to cover the defect. In the case series, failure and complication rates were similar. CONCLUSION The use of an ipsilateral NSF for the transpterygoid management of temporo-sphenoidal meningoceles, although more complex, allows a better coverage of the defect, compared to the contralateral NSF, which is not long enough in 42% of cases.
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Affiliation(s)
- S Bartier
- ENT Department - Skull Base Center, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - B Verillaud
- ENT Department - Skull Base Center, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France
| | - J-P Guichard
- ENT Department - Skull Base Center, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France
| | - R Kania
- ENT Department - Skull Base Center, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France
| | - D Camous
- ENT Department - Skull Base Center, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Herman
- ENT Department - Skull Base Center, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France
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Shastri KS, Leonel LCPC, Patel V, Charles-Pereira M, Kenning TJ, Peris-Celda M, Pinheiro-Neto CD. Lengthening the nasoseptal flap pedicle with extended dissection into the pterygopalatine fossa. Laryngoscope 2019; 130:18-24. [PMID: 30933319 DOI: 10.1002/lary.27984] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Releasing the nasoseptal flap (NSF) pedicle from the sphenopalatine artery (SPA) foramen may considerably improve flap reach and surface area. Our objectives were quantify increases in pedicle length and NSF reach through extended pedicle dissection into the pterygopalatine fossa (PPF) through cadaveric dissections and present clinical applications. STUDY DESIGN Anatomical study and retrospective clinical cohort study. METHODS Twelve cadaveric dissections were performed. Following standard NSF harvest, the distance from the anterior edge of the flap to the anterior nasal spine while pulling the flap anteriorly was measured. As dissection into the SPA foramen and PPF continued, similar interval measurements were completed in four stages after release from the SPA foramen, release of the internal maxillary artery (IMAX), and transection of the descending palatine artery (DPA). The extended pedicle dissection technique was performed in seven consecutive patients for a variety of different pathologies. RESULTS The mean length of the NSF from the anterior nasal spine and maximum flap reach were 1.91 ± 0.40 cm/9.3 ± 0.39 cm following standard harvest, 2.52 ± 0.61 cm/9.75±1.06 cm following SPA foramen release, 4.93 ± 0.89 cm/12.16 ± 0.54 cm following full IMAX dissection, and 6.18 ± 0.68 cm/13.41 ± 0.75 cm following DPA transection. No flap dehiscence or necrosis was observed in all seven surgical patients. CONCLUSIONS Extended pedicle dissection of the NSF to the SPA/IMAX markedly improves the potential length and reach of the flap. This technique may provide a feasible option for reconstruction of large anterior skull base and craniocervical junction defects. Seven successful cases are presented here, but further studies with larger series are warranted to validate findings in a clinical setting. LEVEL OF EVIDENCE 4 Laryngoscope, 130:18-24, 2020.
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Affiliation(s)
- Karthik S Shastri
- Department of Surgery, Division of Otolaryngology/Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A
| | - Luciano Cesar P C Leonel
- Department of Neurosurgery, Albany Medical Center, Albany, New York, U.S.A.,Department of Surgery, Division of Anatomy, University of São Paulo, São Paulo, Brazil
| | - Varun Patel
- Department of Surgery, Division of Otolaryngology/Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A
| | - Marcelo Charles-Pereira
- Department of Surgery, Division of Otolaryngology/Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A
| | - Tyler J Kenning
- Department of Neurosurgery, Albany Medical Center, Albany, New York, U.S.A
| | - Maria Peris-Celda
- Department of Neurosurgery, Albany Medical Center, Albany, New York, U.S.A
| | - Carlos D Pinheiro-Neto
- Department of Surgery, Division of Otolaryngology/Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A.,Department of Neurosurgery, Albany Medical Center, Albany, New York, U.S.A
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Aktuna Belgin C, Colak M, Adiguzel O, Akkus Z, Orhan K. Three-dimensional evaluation of maxillary sinus volume in different age and sex groups using CBCT. Eur Arch Otorhinolaryngol 2019; 276:1493-1499. [PMID: 30879193 DOI: 10.1007/s00405-019-05383-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
Abstract
AIM Sinus maxillaris is an important anatomical formation in many branches of dentistry due to its proximity to the field of work. Various methods have been used in literature to measure the maxillary sinus volume (MSV) such as cadavers, stereology, two-dimensional conventional radiographs, computed tomography (CT), magnetic resonance imaging (MRI). The aim of this study is to evaluate the change of maxillary sinus volume according to age and gender with MIMICS 19.0 (Materialise HQ Technologielaan, Leuven, Belgium) which is one of three-dimensional modeling software. MATERIALS AND METHODS This study was performed in 200 patients selected by a retrospective review of the archives of the Dicle University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology. Patients were divided into five age groups (18-24 years, 25-34 years, 35-44 years, 45-54 years, and ≥ 55 years) and by sex. Cone-beam computed tomography (CBCT) images of the patients were transferred to the MIMICS software and the MSV was measured. All statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 21) software. RESULTS There was no statistically significant difference between the right and left maxillary sinus volume according to the findings obtained from our study, and maxillary sinus volume in males was found to be significantly higher than that of females. Another finding of our study is that the maxillary sinus volume decreases with age increase. Especially it was also found that the sinus volume in males in the 18-24 age group was statistically significantly higher than females. CONCLUSION Consequently, maxillary sinus volume measurements can be made on CT, CBCT, MRI scans using reconstruction software.
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Affiliation(s)
- Ceren Aktuna Belgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hatay Mustafa Kemal University, Hatay, Turkey.
| | - Mehmet Colak
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey
| | - Ozkan Adiguzel
- Department of Endodontics, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey
| | - Zeki Akkus
- Department of Biostatistics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey.,Department of Imaging and Pathology, Faculty of Medicine, Oral and Maxillofacial Surgery, OMFS IMPATH Research Group, University of Leuven, University Hospitals Leuven, Leuven, Belgium
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MacArthur FJD, McGarry GW. The radioanatomy of endonasal flap coverage of skull base defects: A tool for preoperative planning. Laryngoscope 2017; 128:1287-1293. [PMID: 28990662 DOI: 10.1002/lary.26925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/26/2017] [Accepted: 08/24/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a tool for the calculation of surgical skull base defects and endonasal flap dimensions on preoperative computed tomography (CT) to aid surgical planning. STUDY DESIGN Case series. METHODS A literature search was conducted to identify all endonasal flaps. There were five basic models identified. These are the nasoseptal flap, anterior lateral nasal wall flap, bipedicled anterior septal flap, posterior pedicled inferior turbinate flap, and middle turbinate flap. Publications on the radioanatomy of endonasal flaps and surgical skull base defects were also identified. Using these descriptions as a reference, 38 radioanatomic variables were measured on CT scans obtained from 60 preoperative endonasal skull base surgery patients. These were then used to model endonasal flap coverage of six defects: transfrontal, transcribriform, transplanar, transsellar, transsphenoidal, and transclival. RESULTS The nasoseptal provides adequate coverage for most defects. The posteriorly pedicled inferior turbinate flap is a good alternative, and provides better coverage of posterior skull base defects. The anterior lateral nasal wall flap is the best choice for transfrontal defects. The middle turbinate flap and bipedicled anterior septal flaps provide secondary options when larger flaps are not available. CONCLUSIONS We have developed a simple tool for the calculation of endonasal flap coverage of surgical skull base defects on preoperative CT scans. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1287-1293, 2018.
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Affiliation(s)
| | - Gerald W McGarry
- Convener of Education Wade Professor of Surgical Studies , Royal College of Surgeons of Edinburgh, Edinburgh, United Kingdom
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Ten Dam E, Feijen RA, van den Berge MJC, Hoving EW, Kuijlen JM, van der Laan BFAM, Vermeulen KM, Krabbe PFM, Korsten-Meijer AGW. Development of the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire. Int Forum Allergy Rhinol 2017; 7:1076-1084. [PMID: 28834622 DOI: 10.1002/alr.22000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The patients' perspective of health outcomes has become important input for assessing treatment effects. However, existing endoscopic endonasal surgery (EES) instruments are not fully aligned with the concept of health-related quality of life (HRQoL). A prospective cohort study was therefore conducted to develop a suitable quality-of-life tool to assess nasal morbidity after EES: the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q). METHODS The study included 300 patients: 207 with sinus pathology and 93 with anterior skull base pathology. The EES-Q was administered prior to surgery and postoperatively (2 weeks, 3 months, and 1 year). Psychometric instrument properties were tested and relevant health domains were formulated. Seventy-two items were generated by the conventional psychometric approach. An exploratory factor analysis was used to test construct validity. The optimal number of factors to retain was determined by using the eigenvalues-greater-than-1 rule and scree plot. Orthogonal varimax rotation was used to enhance interpretability. Internal consistency was assessed using the Cronbach α. RESULTS The factor analysis yielded a 3-factor solution, representing physical, psychological, and social functioning. The final version of the instrument consisted of 30 items with a high internal consistency (>0.80) for all 3 HRQoL domains. CONCLUSIONS The EES-Q is a comprehensive, multidimensional, disease-specific instrument. A distinguishing characteristic is that, apart from the physical and psychological domains, the EES-Q also encompasses a social domain. Understanding different HRQoL aspects in patients undergoing EES may help caregivers restore, improve, or preserve the patient's health through individualized care, which depends on identifying their specific needs.
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Affiliation(s)
- Ellen Ten Dam
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences Institute for Drug Exploration, University of Groningen, Groningen, The Netherlands
| | - Robert A Feijen
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Minke J C van den Berge
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelco W Hoving
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jos M Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul F M Krabbe
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Astrid G W Korsten-Meijer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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