The turbinal flap: an additional option for anterior skull base reconstruction. Cadaveric feasibility study and case report.

BACKGROUND

Over the past decade, the treatment of complex intradural and extradural pathologies via expanded endonasal approaches has been made possible by progresses and refinements in skull base reconstruction techniques. The aim of this anatomic study is to describe a novel endonasal flap, the turbinal flap (TF), based on the middle and superior turbinate mucosa and pedicled on the ethmoidal arteries system.

METHODS

Three fresh-frozen (6 sides) cadaver heads previously injected with colored silicone were dissected. A step-by-step description of the surgical technique is provided. Vascularization of the TF and its range of possibilities to cover anterior skull base defects were studied. Flap dimensions and area were measured. A case report where the TF was successfully used is also described.

RESULTS

The TF was adequate to repair defects along the entire ethmoid roof. Its pedicle along the skull base was 3.0 cm in length and sagittally oriented. Mean measures of the TF were 3.4 cm (anterior height), 5.5 cm (posterior height), and 4.8 cm (inferior length). Its mean area was 8.6 cm . The flap was supplied by rich network of vessels. A demonstrative case of anterior skull base repair after the endoscopic resection of meningocephalocele of the ethmoid roof is reported.

CONCLUSION

The main indication for the TF is the repair of anterior skull base defects involving the ethmoid roof. Its advantages include the double pedicle, rich vascularization, autonomy from the maxillary artery system, and preservation of the olfactory mucosa.