Anteriorly Based Middle Turbinate Flap for Skull Base Reconstruction: A Cadaveric Study and Case Series.

Objective: To describe a novel flap, the anteriorly based middle turbinate flap (ABMTF), via a cadaveric dissection, as well as present our experience using the ABMTF in 13 patients.

Methods: Cadaver dissection study demonstrating methodology of harvesting the ABMTF. Retrospective chart review of 13 patients from a tertiary rhinology referral center undergoing CSF leak repair using the ABMTF from January 2017 to August 2023. Five cadaveric specimens were utilized to complete the dissection of the ABMTF. Flap dimensions and surface area were measured. A step-by-step surgical technique was recorded to illustrate a video demonstration. Demographic data, BMI, pre and postoperative SNOT 22 scores, size and location of the skull base defect, and flap measurements on computed tomography (CT) were obtained from the electronic medical record.

Results: Five ABMTF were dissected and showed a mean flap surface area for the medial ABMTF of 3.45 cm with a range of 2.5 to 4.46 cm and a mean surface area for the lateral ABMTF of 2 cm. The mean surface area of the flap on CT scan measurements was 3.46 cm. Twelve patients were female, with an average BMI of 35.1 kg/m. Ten out of 13 patients were treated post-operatively with acetazolamide for management of presumed intracranial hypertension. Postoperative SNOT 22 scores significantly improved at the last follow up visit. All patients had excellent flap tissue integration at their latest follow up with no postoperative CSF leak.

Conclusion: The ABMTF is a novel random flap, vascularized by branches of the anterior ethmoid artery, that is effective in skull base reconstruction and CSF leak repair emanating from the anterior skull base between the frontal recess and the posterior ethmoid artery along the ethmoid roof. This flap is versatile with limited morbidity.