Extended Inferior Turbinate Flap for Skull Base Defects

Abstract

Objective: 1) Develop a novel extended inferior turbinate flap (EITF) for endoscopic skull base reconstruction when the nasoseptal flap is unavailable. 2) Describe the anatomic and reconstructive limits of this flap. 3) Understand what types of skull base defects would benefit from this flap.

Method: The EITF was designed for harvest in cadaveric specimens based on the inferior turbinate (IT) artery, a terminal branch of the sphenopalatine artery. The anatomical limits of the EITF were assessed. The arc of rotation and reach for reconstruction of ventral skull base defects were assessed in the cadaver.

Results: The average width of the flap was 55.8 ± 4.1 mm. The average length of the flap was 52.5 ± 5.5 mm. The average surface area was 29.3 ± 4.4 cm². The flap was rotated with the turbinate surface at the inferior aspect of the clival defect, and the extended mucosa of the floor was able to cover the upper portion of the defect. Thus, the angle of rotation was smaller when compared to the 180° angle necessary for the traditional ITF to reach the clivus. The EITF was sufficient to cover defects extending between the paraclival internal carotid arteries.

Conclusion: The EITF presents an additional option for reconstruction of skull base defects when the nasoseptal flap is unavailable or fails. In contrast to the traditionally described ITF, the EITF provides a greater surface area and better arc of rotation.