Reconstruction of large nasal septal perforations with a three layer galeal pericranial flap: an anatomical and technical study

Year 2010, Volume: 20 Issue: 6, 293 - 298, 20.12.2010

Bahar Keleş Kayhan Öztürk Aynur Emine Çiçekçibaşı Mustafa Büyükmumcu

Abstract

Objectives: In this study, a modified surgical method was carried out to repair large nasal septal perforations with a galeal pericranial flap using endoscopic technique. Materials and Methods: Six adult human cadavers were dissected by applying the classic open rhinoplasty technique. Large perforations were created in the septal cartilages. To repair the perforations, we prepared galeal pericranial flaps with supraorbital neurovascular pedicles and calvarial bone grafts under endoscopic visualization. The flaps were inserted between the upper lateral cartilages and folded into three layers. The flaps were sutured to the nasal mucosa with absorbable sutures. The length, the width, the size of the flaps and the perforations were measured using an electronic caliper and a flexible ruler. Results: The mean length and width of the flap pedicles were measured as 26.8±5.1 mm range 20 to 32 mm and 19.3±2.6 mm range 15 to 23 mm , respectively. In addition, the mean length and the width of the flaps were 54.1±4.9 mm range 50 to 60 mm and 51.6±7.8 mm range 45 to 63 mm , respectively. All of the nasal septal perforations were repaired with a galeal pericranial flap. Conclusion: The galeal-pericranial flap is well-vascularized and similar to the nasal mucosa for tissue thickness. Therefore, reconstruction with galeal-pericranial flaps can be an alternative surgical technique for repair of large nasal septal perforations.

Keywords

Calvarial bone graft, endoscopical technique, galeal pericranial flap, nasal septal perforation

Geniş nazal septal perforasyonların üç katmanlı galeal perikranyal flep ile onarımı: Anatomik ve teknik çalışma

Abstract

Amaç: Bu çalışmada, endoskopi tekniği ve galeal perikranyal flep kullanılarak değiştirilmiş cerrahi bir yöntem ile geniş nazal septal perforasyon onarımı yapıldı.Gereç ve Yöntemler: Altı yetişkin insan kadavrası klasik açık rinoplasti tekniği uygulanarak diseke edildi. Septal kıkırdakta geniş perforasyonlar oluşturuldu. Perforasyonların tamiri için, endoskopik görüntüleme altında kalvarial kemik greftleri ve supraorbital nörovasküler pediküllü galeal perikranyal flepler hazırlandı. Flepler üç tabaka şeklinde katlanarak üst yan kıkırdakların arasına yerleştirildi. Flepler emilebilen dikişlerle nazal mukozaya dikildi. Fleplerin uzunlukları, genişlikleri ve perforasyon büyüklükleri, elektronik pergel ve esnek bir cetvel ile ölçüldü.Bulgular: Flep pediküllerinin ortalama uzunluğu ve genişliği sırasıyla, 26.8±5.1 mm dağılım 20-32 mm ve 19.3±2.6 mm dağılım 5-23 mm idi. Buna ek olarak, fleplerin ortalama uzunluğu ve genişliği sırasıyla, 54.1±4.9 mm dağılım 50-60 mm ve 51.6±7.8 mm dağılım 45-63 mm olarak tespit edildi. Tüm nazal septal perforasyonlar galeal perikranyal flepler ile onarıldı.Sonuç: Galeal perikranyal flep iyi vaskülarize ve doku kalınlığı açısından nazal mukozaya benzerdir. Bundan dolayı galeal perikranyal flepler ile rekonstrüksiyon, geniş nazal septal perforasyonların onarımında alternatif bir cerrahi teknik olabilir

Keywords

Kalvarial kemik grefti, endoskopik teknik, galeal perikranyal flep, nazal septal perforasyon

References

• Newton JR, White PS, Lee MS. Nasal septal perfora- tion repair using open septoplasty and unilateral bipedicled flaps. J Laryngol Otol 2003;117:52-5.
• Heller JB, Gabbay JS, Trussler A, Heller MM, Bradley JP. Repair of large nasal septal perforations using facial artery musculomucosal (FAMM) flap. Ann Plast Surg 2005;55:456-9.
• Kridel RW. Septal perforation repair. Otolaryngol Clin North Am 1999;32:695-724.
• Schultz-Coulon HJ. Three-layer repair of nasoseptal defects. Otolaryngol Head Neck Surg 2005;132:213-8.
• Paloma V, Samper A, Cervera-Paz FJ. Surgical tech- nique for reconstruction of the nasal septum: the peri- cranial flap. Head Neck 2000;22:90-4.
• Donath A, Sindwani R. Frontal sinus cranialization using the pericranial flap: an added layer of protec- tion. Laryngoscope 2006;116:1585-8.
• Rodrigues M, O’malley BW Jr, Staecker H, Tamargo R. Extended pericranial flap and bone graft reconstruc- tion in anterior skull base surgery. Otolaryngol Head Neck Surg 2004;131:69-76.
• Noone MC, Osguthorpe JD, Patel S. Pericranial flap for closure of paramedian anterior skull base defects. Otolaryngol Head Neck Surg 2002;127:494-500.
• Smith JE, Ducic Y. The versatile extended pericra- nial flap for closure of skull base defects. Otolaryngol Head Neck Surg 2004;130:704-11.
• Newman J, Costantino P, Moche J. The use of unilateral pericranial flaps for the closure of difficult medial orbital and upper lateral nasal defects. Skull Base 2003; 13:205-9.
• Leatherbarrow B, Watson A, Wilcsek G. Use of the pericranial flap in medial canthal reconstruction: another application for this versatile flap. Ophthal Plast Reconstr Surg 2006;22:414-9.
• Vuyk HD, Versluis RJ. The inferior turbinate flap for closure of septal perforations. Clin Otolaryngol Allied Sci 1988;13:53-7.