Department of Otolaryngology, University off Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Laryngoscope. 2010 Oct;120(10):1922-30. doi: 10.1002/lary.21049.
The expansion of endoscopic endonasal skull base surgery has resulted in an increased demand for reconstructive options. Reconstruction with vascularized tissue has proven indispensable for reliably separating the cranial contents from the paranasal sinuses following extended endoscopic endonasal approaches (EEA). The introduction of the Hadad-Bassagasteguy flap (vascular pedicle nasoseptal flap, HBF) at our institution decreased our postoperative cerebral spinal fluid (CSF) leak rates from more than 20% to less than 5%. The HBF is not always available, as the nasoseptal area or its vascular supply can be compromised by tumor or prior surgery. In an attempt to keep pace with rapidly expanding reconstructive requirements, we present the anatomic and cadaveric foundations for novel modifications of the facial artery musculo (-mucosal) (FAM[M]) and buccinator flaps to allow vascularized reconstruction of the skull base.
Feasibility. Cadaveric study.
Using cadaver dissections and measurements, we investigated the feasibility of transposing pedicled buccinator myo/myomucosal flaps into the nasal cavity and skull base. Both muscular and myomuscular flaps were raised, and techniques for transposition into the nasal cavity were investigated. Three fresh and six preserved human specimens were dissected.
Pedicled facial buccinator flaps with and without mucosa were transposed into the nasal cavity using a variety of maxillary osteotomies. No facial incisions were required. It was demonstrated that the flaps reach the anterior skull base and planum sphenoidale.
The transposition of pedicled buccinator muscle flaps with and without mucosa into the nasal cavity could reach the anterior skull base and planum sphenoidale, if the appropriate surgical technique is used. The pedicled Facial Buccinator Flap holds significant potential as a reconstructive alternative for a variety of skull base defects, alone or in combination with existing reconstructive options. 2010.
内镜经鼻颅底手术的扩展导致对重建选择的需求增加。在采用扩展内镜经鼻入路（EEA）后，为可靠地将颅内容物与鼻旁窦分隔开，使用带血管组织进行重建已被证明是不可或缺的。我们机构引入 Hadad-Bassagasteguy 皮瓣（血管蒂鼻中隔皮瓣，HBF）后，将术后脑脊液（CSF）漏的发生率从 20%以上降低到 5%以下。由于肿瘤或先前的手术可能会损害鼻中隔区域或其血管供应，HBF 并不总是可用的。为了跟上快速扩展的重建需求，我们提出了对面动脉肌（-黏膜）（FAM[M]）和颊肌瓣的解剖和尸体研究基础，以允许颅底的血管重建。
可行性。尸体研究。
使用尸体解剖和测量，我们研究了将带蒂颊肌肌瓣和黏膜瓣转移到鼻腔和颅底的可行性。我们抬起了肌肉瓣和肌黏膜瓣，并研究了将其转移到鼻腔的技术。对 3 个新鲜和 6 个保存的人体标本进行了解剖。
使用各种上颌骨切开术，将带蒂的颊肌颊肌瓣和带黏膜的颊肌瓣转移到鼻腔。无需进行面部切口。研究表明，皮瓣可以到达颅前底和蝶骨平台。
如果采用适当的手术技术，带蒂颊肌肌瓣和带黏膜的颊肌瓣可以转移到鼻腔，从而到达颅前底和蝶骨平台。带蒂颊肌瓣具有作为各种颅底缺损的重建替代的巨大潜力，可单独使用或与现有的重建选择联合使用。2010 年。
