Impact of Reverse Septal Flap on Morbidity of Nasoseptal Flap Reconstruction of Skull Base Defects

Abstract

Background

The workhorse for endonasal reconstruction of skull base defects is the posteriorly-based nasoseptal flap (NSF). Postoperative nasal deformities and decreased olfaction are potential complications of NSF. The reverse septal flap (RSF) minimizes the donor site morbidity of the NSF by covering the exposed cartilage of the anterior septum. Currently, there are minimal data examining its effect on outcomes including nasal dorsum collapse and olfaction.

Objective

Our study aims to clarify whether the RSF should be utilized when the option exists.

Methods

Adult patients undergoing endoscopic endonasal approach (EEA) surgery of the skull base (transsellar/transplanum/transclival approaches) with NSF reconstruction were identified. Data from 2 separate cohorts, one retrospective and one prospective, were collected. Follow-up was at least 6 months. Patients were photographed preoperatively and postoperatively using standard rhinoplastic nasal views. Patients completed the University of Pennsylvania Smell Identification Test (UPSIT) and the 22-item Sino-Nasal Outcome Test (SNOT-22) preoperatively and postoperatively and were also queried regarding subjective changes in nasal appearance and plans for cosmetic surgery following EEA.

Results

There were no statistically significant differences in the change in UPSIT and SNOT-22 scores between patients receiving RSF and other reconstructive groups (either NSF without RSF or no NSF). One of 25 patients who were reconstructed with an NSF with RSF reported a change in nasal appearance; none were considering reconstructive surgery. The proportion of patients reporting changes in appearance was significantly lower in the NSF with RSF group as compared to the NSF without RSF group (P = .012).

Conclusion

The use of an RSF to limit donor site morbidity of the NSF was shown to significantly decrease the proportion of patients who reported nasal deformities and did not show a significant difference in patient-reported sinonasal outcomes. Given these findings, RSF should be considered whenever an NSF is used for reconstruction.

Keywords

skull base surgery nasal septum surgery reconstructive surgical procedures surgical flaps nasoseptal flap reverse septal flap nasal deformity olfaction endoscopic nasal surgery saddle nose deformity

Get full access to this article

View all access options for this article.

References

Hadad

Bassagasteguy

Carrau

, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882–1886.

Rowan

Wang

Gardner

, et al. Nasal deformities following nasoseptal flap reconstruction of skull base defects. J Neurol Surg B Skull Base. 2016;77(1):14–18.

Kasemsiri

Carrau

Otto

, et al. Reconstruction of the pedicled nasoseptal flap donor site with a contralateral reverse rotation flap: technical modifications and outcomes. Laryngoscope. 2013;123(11):2601–2604.

Doty

Shaman

Kimmelman

, et al. University of Pennsylvania Smell Identification Test: a rapid quantitative olfactory function test for the clinic. Laryngoscope. 1984;94(2 Pt 1):176–178.

Rudmik

Hopkins

Peters

, et al. Patient-reported outcome measures for adult chronic rhinosinusitis: a systematic review and quality assessment. J Allergy Clin Immunol. 2015;136(6):1532–1540.

Rowan

Valappil

Chen

, et al. Prospective characterization of postoperative nasal deformities in patients undergoing endoscopic endonasal skull-base surgery. Int Forum Allergy Rhinol. 2020;10(2):256–264.

DeConde

Mace

Bodner

. SNOT-22 quality of life domains differentially predict treatment modality selection in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(12):972–979.

Caicedo-Granados

Carrau

Snyderman

, et al. Reverse rotation flap for reconstruction of donor site after vascular pedicled nasoseptal flap in skull base surgery. Laryngoscope. 2010;120(8):1550–1552.

Nayak

Rathor

Grayson

. Porcine small intestine submucosal grafts improve remucosalization and progenitor cell recruitment to sites of upper airway tissue remodeling. Int Forum Allergy Rhinol. 2018;8(10):1162–1168.

10.

Kimple

Leight

Wheless

. Reducing nasal morbidity after skull base reconstruction with the nasoseptal flap: free middle turbinate mucosal grafts. Laryngoscope. 2012;122(9):1920–1924.