Department of Otolaryngology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Laryngoscope. 2010 Sep;120(9):1798-801. doi: 10.1002/lary.20996.
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.
Retrospective clinical review.
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.
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.
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.
目的/假设：Hadad-Bassagasteguy 带蒂鼻中隔瓣的血液供应可能会被翼腭窝手术、后鼻中隔切除术或大的蝶窦切开术中断。这将排除其在经扩大经鼻内镜入路（EEA）后用于重建颅底缺损的用途。我们提出了一种新的方法，使用声多普勒超声来确定先前手术后鼻中隔动脉的通畅性，从而确定鼻中隔瓣的可用性。
回顾性临床研究。
对 4 名接受 EEA 的患者进行了术中声多普勒超声检查。用探头尖端扫描覆盖蝶窦额突下表面的粘膜。评估代表血管内血流的声波反射。
在 3 名患者中，至少在一侧识别出了动脉。还有一名患者没有声信号提示双侧鼻中隔动脉缺失，因此需要使用脂肪移植物进行重建。
声多普勒超声似乎是一种可行且有效的确定鼻中隔动脉可用性的方法。它是一种相对便宜且简单的技术，任何内镜外科医生都可以进行。
