Section and repositioning of the inferior turbinate in the design of extended septal flaps

Abstract

Background and objective: Nasoseptal or septal flaps extended to the floor of the fossa and inferior meatus are a resource in the reconstruction of extended endoscopic approaches. We propose the technique of sectioning and repositioning the inferior turbinate to facilitate the design of these extended pedicled flaps.

Material and methods: We evaluated 3 cases operated with a skull base lesion: a craniopharyngioma, a petroclival meningioma and a post-surgical fistula of cerebrospinal fluid in the cribiform plate, in which sectioning and repositioning of the inferior turbinate was performed prior to the design of a septal or nasoseptal flap extended to the floor and inferior meatus. To evaluate the anatomy and function of the inferior turbinate, we analyzed the results of acoustic rhinometry three months after surgery with and without vasoconstrictor.

Results: The pedicled flaps remained visible and vital on endoscopic examination. The area of the C notch obtained by acoustic rhinometry, in the nostril where the turbinate was manipulated, was in all three cases the narrowest area of the nasal cavity. The mean area for the C-notch was 0,34 cm², 0,74 cm² y de 0,30 cm² at a distance from the nostril of 2,20 cm, 2,31 cm and 1,93 cm respectively.

Conclusion: Performing a section and subsequent repositioning of the inferior turbinate, prior to designing an endonasal pedicled flap that includes the mucosa of the floor and inferior meatus, can greatly facilitate obtaining a larger reconstruction flap without affecting the functionality of the inferior turbinate itself.

Keywords: Acoustic rhinometry; C notch; Colgajo nasoseptal ampliado; Colgajo septal ampliado; Cornete inferior; Escotadura C; Extended nasoseptal flap; Extended septal flap; Inferior turbinate; Rinometría acústica.