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Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects.

Publication ,  Conference
Shah, RN; Surowitz, JB; Patel, MR; Huang, BY; Snyderman, CH; Carrau, RL; Kassam, AB; Germanwala, AV; Zanation, AM
Published in: Laryngoscope
June 2009

OBJECTIVES/HYPOTHESIS: A prospective study of endoscopic expanded endonasal approaches (EEA) with nasoseptal flap reconstructions revealed anecdotal evidence of less available relative septal length in pediatric patients. Our goal is to use radioanatomic analysis of computed tomography (CT) scans to determine limitations of the nasoseptal flap in pediatric skull base reconstruction and to describe clinical outcomes after using the nasoseptal flap in six pediatric patients. STUDY DESIGN: Six pediatric patients who underwent EEA with nasoseptal flap reconstruction were prospectively analyzed for flap coverage and postoperative cerebrospinal fluid (CSF) leak. Fifty maxillofacial CTs of individuals <18 years of age and 10 adult images underwent radioanatomic analysis. METHODS: Measurements included potential nasoseptal flap dimensions and dimensions required to reconstruct an anterior skull base defect, a trans-sellar defect, and a transclival defect. Measurements were compared to determine if flap size would be sufficient to cover independent EEA defects within different age groups. RESULTS: Two out of three patients <14 years of age had inadequate flap coverage; one had a postoperative CSF leak. Patients >14 years of age had adequate flap coverage. Average potential flap length is less than average anterior skull base length until age 9 years to 10 years, and less than average trans-sellar defect length until age 6 years to 7 years. Septal growth is most rapid between 10 years and 13 years. CONCLUSIONS: : The pedicled nasoseptal flap may not be a viable option for EEA reconstruction in children <10 years of age. This flap is a reliable option in patients >14 years of age, as their septums are comparable to adults. Patients 10 years to 13 years of age require careful consideration of facial analysis and preoperative radioanatomic evaluation on an individual basis. Laryngoscope, 2009.

Duke Scholars

Published In

Laryngoscope

DOI

EISSN

1531-4995

Publication Date

June 2009

Volume

119

Issue

6

Start / End Page

1067 / 1075

Location

United States

Related Subject Headings

  • Young Adult
  • Wounds, Gunshot
  • Tomography, X-Ray Computed
  • Surgical Flaps
  • Skull Base Neoplasms
  • Skull Base
  • Risk Factors
  • Postoperative Complications
  • Pituitary Neoplasms
  • Otorhinolaryngology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Shah, R. N., Surowitz, J. B., Patel, M. R., Huang, B. Y., Snyderman, C. H., Carrau, R. L., … Zanation, A. M. (2009). Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. In Laryngoscope (Vol. 119, pp. 1067–1075). United States. https://doi.org/10.1002/lary.20216
Shah, Rupali N., Joshua B. Surowitz, Mihir R. Patel, Benjamin Y. Huang, Carl H. Snyderman, Ricardo L. Carrau, Amin B. Kassam, Anand V. Germanwala, and Adam M. Zanation. “Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects.” In Laryngoscope, 119:1067–75, 2009. https://doi.org/10.1002/lary.20216.
Shah RN, Surowitz JB, Patel MR, Huang BY, Snyderman CH, Carrau RL, et al. Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. In: Laryngoscope. 2009. p. 1067–75.
Shah, Rupali N., et al. “Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects.Laryngoscope, vol. 119, no. 6, 2009, pp. 1067–75. Pubmed, doi:10.1002/lary.20216.
Shah RN, Surowitz JB, Patel MR, Huang BY, Snyderman CH, Carrau RL, Kassam AB, Germanwala AV, Zanation AM. Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope. 2009. p. 1067–1075.
Journal cover image

Published In

Laryngoscope

DOI

EISSN

1531-4995

Publication Date

June 2009

Volume

119

Issue

6

Start / End Page

1067 / 1075

Location

United States

Related Subject Headings

  • Young Adult
  • Wounds, Gunshot
  • Tomography, X-Ray Computed
  • Surgical Flaps
  • Skull Base Neoplasms
  • Skull Base
  • Risk Factors
  • Postoperative Complications
  • Pituitary Neoplasms
  • Otorhinolaryngology