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Cranial Base

Reducing nasal morbidity after skull base reconstruction with the nasoseptal flap: Free middle turbinate mucosal grafts

  1. Adam J. Kimple MD, PhD1,
  2. W. Derek Leight MD2,
  3. Stephen A. Wheless MD3,
  4. Adam M. Zanation MD1,*

Article first published online: 1 AUG 2012

DOI: 10.1002/lary.23325

Issue

The Laryngoscope

The Laryngoscope

Volume 122, Issue 9, pages 1920–1924, September 2012

Additional Information

How to Cite

Kimple, A. J., Leight, W. D., Wheless, S. A. and Zanation, A. M. (2012), Reducing nasal morbidity after skull base reconstruction with the nasoseptal flap: Free middle turbinate mucosal grafts. The Laryngoscope, 122: 1920–1924. doi: 10.1002/lary.23325

Author Information

  1. 1

    Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

  2. 2

    Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska

  3. 3

    Division of Otolaryngology–Head and Neck Surgery, University of Vermont, Burlington, Vermont, U.S.A.

*Department of Otolaryngology–Head and Neck Surgery, University of North Carolina Memorial Hospitals, 170 Manning Dr., Ground Floor Physician Office Building, CB#7070, Chapel Hill, NC 27599

Publication History

  1. Issue published online: 23 AUG 2012
  2. Article first published online: 1 AUG 2012
  3. Accepted manuscript online: 28 MAR 2012 11:05AM EST
  4. Manuscript Accepted: 1 MAR 2012
  5. Manuscript Revised: 13 FEB 2012
  6. Manuscript Received: 4 DEC 2011

Funded by

  • UNC MD/PhD program (T32 GM008719)
  • National Institute of Mental Health. Grant Number: F30 MH074266
  • Doris Duke Charitable Foundation

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Keywords:

  • Skull base reconstruction;
  • nasoseptal flap;
  • free mucosal graft;
  • middle turbinate graft;
  • Level of Evidence: 1b

Abstract

Objectives/Hypothesis:

The nasoseptal flap provides hearty vascularized tissue for reconstruction of expanded endonasal approaches (EEA); however, it produces donor site morbidity due to exposed cartilage. Mucosalization of the septum requires 12 weeks, multiple debridements, and frequent saline rinses. This study addresses the reduction of nasal morbidity by grafting middle turbinate mucosa onto the exposed septum.

Study Design:

Small prospective study with retrospective analysis of a larger cohort.

Methods:

Fifteen patients undergoing EEA of the ventral skull base were prospectively enrolled. In seven cases, the sacrificed middle turbinate mucosa was harvested and placed as a free mucosal graft on the septal cartilage. In eight controls, middle turbinate grafting was not performed due to tumor involvement. Septal mucosalization and crusting of all patients was quantified at follow-up appointments. An additional 46 patients were retrospectively identified who received middle turbinate grating on their exposed septal cartilage, and mucosalization rates were determined from clinical records.

Results:

Three weeks after initial operation, the mucosalization rate was 70% versus 5% in the graft and nongraft groups, respectively. At postoperative week 6, the mucosalization and crusting were 97% and 5% for the graft group versus 60% and 85% for the nongraft group. Mucosalization rates in the retrospective graft series agreed with the prospective series.

Conclusions:

Despite donor site morbidity, the nasoseptal flap is becoming the standard of care for skull base reconstruction due to its reliability in reestablishing a barrier between the subarachnoid space and the sinonasal tract. It is possible to dramatically increase the rate of septal mucosalization and decrease crusting by using a middle turbinate free mucosal graft. Laryngoscope, 2012

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