Use of acoustic doppler sonography to ascertain the feasibility of the pedicled nasoseptal flap after prior bilateral sphenoidotomy

Authors

  • Carlos D. Pinheiro-Neto MD,

    1. Department of Otolaryngology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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  • Ricardo L. Carrau MD,

    Corresponding author
    1. Neuroscience Institute, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
    • Neuroscience Institute, John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA 90404
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  • Daniel M. Prevedello MD,

    1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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  • Juan C. Fernandez-Miranda MD,

    1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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  • Carl S. Snyderman MD,

    1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    2. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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  • Paul A. Gardner MD,

    1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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  • Amin B. Kassam MD

    1. Neuroscience Institute, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
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  • Amin B. Kassam, MD is a paid consultant for Karl Storz-Endoscopy and Stryker Navigation and holds equity stake in NICO Corporation. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Blood supply to the Hadad-Bassagasteguy pedicled nasoseptal flap may be interrupted by surgery of the pterygopalatine fossa, posterior septectomy, or large sphenoidotomies. This would preclude its use for reconstruction of skull base defects after expanded endonasal approaches (EEA). We present a novel method to ascertain the patency of the nasoseptal artery after prior surgery, and consequently the availability of the nasoseptal flap, using acoustic Doppler sonography.

Study Design:

Retrospective clinical review.

Methods:

Four patients who underwent EEAs were evaluated intraoperatively with acoustic Doppler sonography. The mucosa that covers the inferior aspect of the rostrum of the sphenoid sinus was scanned with the tip of the probe. Reflection of sound waves representing intravascular blood flow was assessed.

Results:

In three patients, the artery was identified in at least one side. One remaining patient showed no acoustic signal suggesting loss of the nasoseptal artery bilaterally, therefore necessitating the use of a fat graft for the reconstruction.

Conclusions:

Acoustic Doppler sonography seems to be a feasible and effective way to ascertain the availability of the nasoseptal artery. It is a relatively inexpensive and simple technique that can be performed by any endoscopic surgeon. Laryngoscope, 2010

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