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Bilateral modified nasoseptal “rescue” flaps in the endoscopic endonasal transsphenoidal approach

Authors

  • Boo Young Kim MD,

    1. Department of Otolaryngology–Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • Ji-Hyeon Shin MD,

    1. Department of Otolaryngology–Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • Seok-Gu Kang MD, PhD,

    1. Department of Neurosurgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • Sung Won Kim MD, PhD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
    2. Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
    • Send correspondence to Sung Won Kim, MD, PhD, Department of Otolaryngology–Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, 137–701, Korea. E-mail: kswent@catholic.ac.kr

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  • Yong Kil Hong MD, PhD,

    1. Department of Neurosurgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • Sin-Soo Jeun MD, PhD,

    1. Department of Neurosurgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
    2. Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • Soo Whan Kim MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • Jin Hee Cho MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • Yong Jin Park MD, PhD

    1. Department of Otolaryngology–Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

For a wide exposure of skull base and preservation of septal mucosa, we have raised bilateral modified nasoseptal rescue flaps in the endoscopic endonasal transsphenoidal approach (EETSA) and evaluated the usefulness of these flaps elevation.

Study Design

Case series.

Methods

The study population comprised the patients who underwent EETSA with bilateral modified nasoseptal rescue flaps elevation between February 2009 and June 2012. We retrospectively reviewed patients' medical records. Patients underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively.

Results

A total of 92 patients underwent the EETSA with bilateral modified nasoseptal rescue flaps elevation. A total of 17 patients had intraoperative cerebrospinal fluid (CSF) leakage. Three patients underwent extension of the modified nasoseptal rescue flap to a conventional nasoseptal flap. No patients underwent reoperation due to CSF leakage. There was no statistical difference between preoperative and postoperative total SNOT-20 and NOSE scores. According to the VAS, subjective olfaction function statistically worsened (P = 0.011) postoperatively.

Conclusion

Bilateral modified nasoseptal rescue flaps elevation provided good exposure of the sellar floor, preserved the septal branch of sphenopalatine artery, and facilitated removal of sellar tumors. We could also preserve more septal mucosa by designing a novel incision and repositioning unused flaps to their original sites. Postoperative complications of the nasal cavity were thus minimized. We believe that this flap is very useful in a variety of settings during the EETSA.

Level of Evidence

4. Laryngoscope, 123:2605–2609, 2013

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