Clinical utility of the inferior turbinate flaps in the reconstruction of the nasal septum and skull base.

PURPOSE: The inferior turbinate flaps (ITFs) include the anterior pedicle inferior turbinate flap (APITF) and the posterior pedicle inferior turbinate flap (PPITF). The APITF has been used for the repair of the septal perforation, and the PPITF has been used for the reconstruction of the skull base. Because of the technical difficulties of endoscopic preparation of the ITF, clinical studies on endoscopic management with the ITFs have been sporadic.

METHODS: We retrospectively reviewed 11 patients who underwent endoscopic reconstruction with the ITFs at our institutions from 2006 to 2010. The APITF had been used for the repair of the septal perforation and reconstruction of mucosal defect following excision of a septal tumor, and the PPITF had been used for the reconstruction of the skull base. Clinical data included characteristics of septal perforation and skull base defect, including defect size, types of the ITFs, repair techniques, and complications.

RESULTS: Pathology included septal perforation (n = 4), pleomorphic adenoma (n = 2), ethmoid teratocarcinosarcoma (n = 1), and pituitary adenoma (n = 4). The 6 septal lesions were reconstructed with the APITF. The size of the septal mucosal defects ranged from 5 to 18 mm, and the success rate of APITF septal defect repair was 83.3% (5/6 patients). A patient with a tiny residual septal perforation was symptom-free. There was no full-thickness necrosis of the flap. Postoperatively, there was no excessive crusting or empty nose syndrome. The 5 skull base defects following endoscopic skull base surgery were repaired with the PPITF, where the nasoseptal flap was not available because of surgical loss of the nasal septum, operative injury to the posterior nasoseptal artery, or previous use of the nasoseptal flap. The sites of skull base reconstruction included the sellar floor (n = 3), clivus (n = 1), and posterior ethmoid (n = 1). Flap necrosis was noted in 2 patients who underwent surgery in the early period of this series, and the success rate of the PPITF was 60%. However, after acquisition of surgical skills, improved viability of the flap became evident.

CONCLUSIONS: Inferior turbinate flaps could be a feasible alternative in the repair of the nasal septum and skull base. Although endoscopic application of ITFs requires a considerable learning curve, increased familiarity with these flaps would improve flap survival and treatment outcome of reconstruction of the nasal septum and skull base.