Blood supply protection of the ipsilateral nasal septal flap and its application in the skull base surgery under nasal endoscope via transpterygoid approach
Objective To sum up the experience with the key technical points for preparation of the ipsilateral nasal septal flap and its efficacy of application in the skull base surgery under nasal endoscope via transpterygoid approach.Methods A retrospective analysis was made among 7 cases with nasopharyngeal necrosis following radiotherapy to the nasopharynx and 5 cases with meningoencephalocele in the lateral recess of sphenoid sinus,all treated by the procedures of skull base surgery under nasal endoscope via transpterygoid approach in our department from Mar.2021 to Feb.2022.During the operation,the ipsilateral nasal septal flap was separated to its root around the sphenopalatine foramen and overturned laterally to expose the pterygoid process well,with the supplying artery to the flap protected intactly.Then,summarized up were the key technical points on the preparation of the ipsilateral nasal septal flap and the efficacy of the flap applied in this kind of surgery.Results All these 12 cases were observed with their flaps survived well in the surgical field,with satisfactory epithelialization in the surgical field.Postoperatively,headache and nasal odor,the most frequently seen symptoms among cases with nasopharyngeal necrosis induced by radiation,were improved obviously,with no numbness on the face or soft and hard palate.Then,the other 5 cases with meningiencephalocele in the lateral recess of sphenoid sinus complicated with cerebrospinal fluid rhinorrhea were all cured,but with 2 cases feeling numbness on face and 3 cases feeling numbness in soft and hard palate postoperatively.Conclusion Ipsilateral septum mucosal flap can be used to effectively repair the pathological wounds or defect in the nasopharynx,lateral sphenoidal recess and skull base,induced either by radiation or other pathological damage,during the skull base surgery under nasal endoscope via transpterygoid approach,once the blood supply to the flap being preserved well.
transpterygoid approached skull base surgeryipsilateral septal flapsupplying artery preservationclinical applicationefficacy
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