Harvey Richard J, Sheahan Patrick O, Schlosser Rodney J
Department of Otolaryngology/Skull Base Surgery, St. Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia.
Am J Rhinol Allergy. 2009 Sep-Oct;23(5):522-6. doi: 10.2500/ajra.2009.23.3354.
Endoscopic skull base reconstruction (ESBR) is an important advance in the management of skull base defects. Large dural defects usually require the use of pedicled mucosal flaps for successful repair and prevention of cerebral spinal fluid leak. Planning for pedicled flaps is important because raising the flap is often required before tumor removal or initial surgical access. The potential utility of the inferior turbinate pedicled flap (ITPF) in ESBR is assessed.
The ITPF was raised in nine cadaver heads. The most anterior extent reached on the anterior cranial fossa (ACF) and inferior limit on the posterior cranial fossa (PCF) were recorded with image-guided surgery. Measurements were calculated as a percentage of ACF or PCF length from easily reproducible measurements from preoperative radiology. The width was defined as the widest measurement in the distal third. The length-to-height ratio of the skull base was also assessed as a confounding factor.
Mean length for the ITPF was 54.0+/-4.9 mm with a width of 22.1+/-3.7 mm. The mean reach was 112+/-21% (range, 90-150%) of the PCF. The ACF was less accessible with a mean reach of 67+/-9.9% (range, 52-84%). The skull base proportions did not have a strong association on utility (p=0.74 and 0.29).
ITPF presents one option for ESBR of larger skull base defects. It has several limitations with access to the anterior ACF. The ITPF may be an excellent salvage flap when previous septectomy has been performed or with septal involvement by tumor. Careful preoperative assessment of potential defect can estimate the reach of the ITPF.
内镜下颅底重建（ESBR）是颅底缺损治疗方面的一项重要进展。大型硬脑膜缺损通常需要使用带蒂黏膜瓣才能成功修复并预防脑脊液漏。规划带蒂瓣很重要，因为通常需要在肿瘤切除或初次手术入路之前掀起瓣。评估下鼻甲带蒂瓣（ITPF）在ESBR中的潜在效用。
在九个尸头中掀起ITPF。使用图像引导手术记录在前颅窝（ACF）上达到的最前端范围以及在后颅窝（PCF）上的下限。测量值以术前放射学中易于重复测量的ACF或PCF长度的百分比计算。宽度定义为远端三分之一处的最宽测量值。还评估了颅底的长宽比作为混杂因素。
ITPF的平均长度为54.0±4.9毫米，宽度为22.1±3.7毫米。平均到达范围为PCF的112±21%（范围为90 - 150%）。ACF的可达性较差，平均到达范围为67±9.9%（范围为52 - 84%）。颅底比例与效用没有很强的关联（p = 0.74和0.29）。
ITPF是大型颅底缺损ESBR的一种选择。它在进入前ACF方面有一些局限性。当先前已进行鼻中隔切除术或肿瘤累及鼻中隔时，ITPF可能是一种出色的补救瓣。对潜在缺损进行仔细的术前评估可以估计ITPF的可达范围。
