The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction

Laryngoscope. 2007 Aug;117(8):1329-32. doi: 10.1097/mlg.0b013e318062111f.


Background: Expanded endonasal approaches (EEA) for the resection of lesions of the anterior and ventral skull base can create large defects with a significant risk of postoperative cerebrospinal fluid (CSF) leaks or exposure of the internal carotid artery. In these cases, a reconstruction using a vascularized flap facilitates rapid and complete healing of the defect. The Hadad-Bassagasteguy flap (HBF), a posterior pedicle nasoseptal flap, is our preferred reconstructive option; however, a prior posterior septectomy or prior wide sphenoidotomies preclude its use. We have developed two additional pedicled flaps to reconstruct these selected patients: the transpterygoid temporoparietal fascia flap, which is suitable for large defects, and the posterior pedicle inferior turbinate flap (PPITF), the subject of this paper.

Methods: We developed a flap comprising the inferior turbinate mucoperiosteum pedicled on the inferior turbinate artery, a terminal branch of the posterior lateral nasal artery, which arises from the sphenopalatine artery. We retrospectively reviewed the clinical data of four patients who underwent a skull base reconstruction using a PPITF.

Results: Four patients underwent a reconstruction with the PPITF after undergoing an EEA that produced a skull base defect associated with a CSF fistula (n = 2), an exposed internal carotid artery (n = 1), or a basilar aneurysm clip (n = 1). All patients had undergone posterior septectomies as part of previous EEAs. All flaps healed uneventfully and covered the entire defect.

Conclusion: The PPITF is a viable reconstructive option for patients with skull base defects of a limited size defect and in whom the HBF is not available.

MeSH terms

  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nose / surgery*
  • Plastic Surgery Procedures / methods*
  • Retrospective Studies
  • Skull Base Neoplasms / complications*
  • Skull Base Neoplasms / surgery
  • Subdural Effusion / etiology
  • Subdural Effusion / surgery*
  • Surgical Flaps / blood supply*
  • Treatment Outcome