Utilising Free Middle Turbinate Mucosal Grafts to Reconstruct the Septal Donor Site Following Nasoseptal Flap Harvesting in Endoscopic Endonasal Approach for Sellar and Parasellar Lesions.

Abstract

Introduction: The nasoseptal flap (NSF) has become a widely favoured choice for reconstructing skull base defects following the endoscopic endonasal approach (EEA). However, the exposed septal cartilage and bone at the donor site often require an extended duration for secondary healing. This study investigated whether the free middle turbinate (MT) mucosa grafting at the septal donor site could mitigate post-operative nasal morbidity.

Methods: We retrospectively reviewed patients with sellar and parasellar lesions who underwent NSF harvesting in EEA between 2015 and 2023. In most cases, the MT mucosa was harvested as a free mucosal graft and placed on the exposed nasal septal donor site. The degree of septal mucosalisation and the presence of nasal crusting were assessed during follow-up appointments.

Results: A total of 104 patients were included in this study, comprising 41 males and 63 females. All patients underwent NSF harvesting for skull base defect reconstruction and 99 patients received MT mucosa grafting at the septal donor site. The average duration for complete mucosalisation of the exposed septal cartilage with the MT graft was 38.7 days, significantly different from 59.6 days for patients without the MT graft (p < 0.0001). At the 3-month post-operative follow-up, 34% of the patients with MT graft displayed no crusting compared to 20% of patients without MT graft.

Conclusions: The use of free MT mucosal grafting represents a promising technique for improving mucosalization and minimising crusting at the nasal septal donor site following the harvest of the NSF in EEA for sellar and parasellar lesions.