Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Laryngoscope. 2022 Aug;132(8):1561-1568. doi: 10.1002/lary.30079. Epub 2022 Feb 28.
While pedicled intranasal flaps, such as the nasoseptal flap (NSF), successfully reduce postoperative CSF leaks following endoscopic endonasal approaches (EEA) to the skull base, morbidity remains prevalent. This study describes the first cadaveric description and radiographic analysis of the posterior septal nasal floor mucosal flap (PSNF) designed to reduce pedicled nasal flap morbidity. A case series is also detailed.
Cadaveric dissection, radiographic analysis, and case series.
Seven cadaver specimens underwent harvest of the PSNF. PSNF flap dimensions were measured on the thirty deidentified sinus computed tomography (CT) scans. A retrospective case series was performed on the first set of patients who received the PSNF for reconstruction of a sellar base defect. Information concerning complications, symptoms, and the appearance of the flap was recorded from records of the patient's postoperative inpatient stay, 1-week postop visit, and 1-month postop visit.
Cadaver dissection of the PSNF flap demonstrated good arc rotation along its pedicle with ability to cover both sellar and planum defects. Cadaveric flap measurements and CT-derived measurements estimated a mean surface area of 16.7 and 18.3 cm , respectively. 15 patients underwent reconstruction of a sellar or planum defect using the PSNF technique. Only one CSF leak was encountered postoperatively. Minimal crusting of the flap and donor site was seen 1 month postoperatively.
The PSNF flap provides a sizeable pedicled region for reconstruction comparable to other pedicled nasal flaps. Our case series demonstrated good postoperative outcomes without reduced donor site morbidity.
4 Laryngoscope, 132:1561-1568, 2022.
尽管带蒂鼻腔内皮瓣（如鼻中隔鼻瓣）成功减少了内镜经鼻颅底入路（EEA）后术后脑脊液漏，但发病率仍然很高。本研究描述了首例旨在减少带蒂鼻瓣发病率的后鼻中隔鼻底黏膜瓣（PSNF）的尸体描述和放射分析，并详细介绍了一个病例系列。
尸体解剖、放射分析和病例系列。
7 具尸体标本进行了 PSNF 的采集。在 30 份匿名鼻窦 CT（CT）扫描上测量 PSNF 瓣的尺寸。对第一组接受 PSNF 重建鞍底缺损的患者进行了回顾性病例系列研究。从患者术后住院、术后 1 周和 1 个月的随访记录中记录了并发症、症状和瓣的外观等信息。
PSNF 瓣的尸体解剖显示，其蒂部可沿良好的弧形旋转，能够覆盖鞍部和平面缺陷。尸体瓣测量和 CT 衍生测量分别估计平均表面积为 16.7 和 18.3cm。15 例患者采用 PSNF 技术重建鞍部或平面缺陷。仅 1 例术后发生脑脊液漏。术后 1 个月可见瓣和供区轻微结痂。
PSNF 瓣为重建提供了可与其他带蒂鼻瓣相媲美的大面积带蒂区域。我们的病例系列研究表明，术后结果良好，供区并发症发病率未降低。
4 级《喉镜》，132：1561-1568，2022。
