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

IF 2.5 3区 医学 Q1 OTORHINOLARYNGOLOGY
William A Strober, Benita Valappil, Carl H Snyderman
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引用次数: 1

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.

逆行鼻中隔瓣对鼻中隔瓣重建颅底缺损发病率的影响。
背景:鼻内重建颅底缺损的主要方法是后基鼻中隔瓣(NSF)。术后鼻畸形和嗅觉下降是NSF的潜在并发症。逆行鼻中隔皮瓣(RSF)通过覆盖前鼻中隔暴露的软骨,最大限度地减少了NSF的供区发病率。目前,研究其对鼻背塌陷和嗅觉等预后影响的数据很少。目的:我们的研究旨在澄清是否应该使用RSF当选择存在。方法:对经鼻内窥镜颅底入路(经鞍/经肺/经巩膜入路)重建NSF的成年患者进行鉴定。收集了2个独立队列的数据,一个是回顾性的,一个是前瞻性的。随访至少6个月。患者术前和术后使用标准鼻整形镜拍照。患者术前和术后均完成了宾夕法尼亚大学嗅觉识别测试(UPSIT)和22项中鼻结果测试(SNOT-22),并询问了EEA后鼻腔外观的主观变化和整容手术计划。结果:接受RSF的患者与其他重建组(无RSF或无NSF)的UPSIT和SNOT-22评分变化无统计学差异。25例重建NSF伴RSF的患者中有1例报告鼻腔外观改变;没有人考虑进行重建手术。NSF合并RSF组报告外观改变的患者比例明显低于无RSF组(P = 0.012)。结论:使用非鼻窦炎来限制非鼻窦炎供体部位的发病率,可以显著降低报告鼻部畸形的患者比例,并且在患者报告的鼻窦预后方面没有显着差异。考虑到这些发现,无论何时使用NSF进行重建,都应考虑RSF。
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来源期刊
CiteScore
5.60
自引率
11.50%
发文量
82
审稿时长
4-8 weeks
期刊介绍: The American Journal of Rhinology & Allergy is a peer-reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials, and review articles.
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