The Application of a Free Nasal Floor Mucoperiosteal Graft in Endoscopic Sinus Surgery

Abstract

Background Numerous reconstructive techniques and materials have been reported for repair of skull base defects, cerebrospinal fluid (CSF) leaks, and coverage of denuded bone, including pedicled vascularized flaps and free mucosal grafts. Objective This study described our technique of harvesting and transferring a free nasal floor mucoperiosteal graft and discussed our experience with the application of this technique. Methods A retrospective review of 19 patients (mean age, 53.7 years; 13 men, 6 women) treated with image-guided endoscopic sinus surgery for chronic rhinosinusitis or tumors. Intraoperative free mucosal graft repair was performed for large skull base defects after resection of skull base tumor (n = 7), CSF leak (n = 12), and iatrogenic CSF leak (n = 7). Repair was performed in an overlay or an underlay fashion, with a multilayer approach in cases of a large skull base defect. Patients underwent endoscopic assessment at 6 days, 5 weeks, and 12 weeks after surgery for assessment of healing and of CSF leak. The patients were followed up for a mean of 8.7 months. Results Minimal crusting was identified at the donor site in all the patients at 6 days, with no evidence of CSF leak. In cases of exposed bone and/or mucosal stripping, hyperostosis at the recipient graft site was avoided. All the patients had complete healing at the donor site and the recipient site, with minimal morbidity at 5 and 12 weeks, and no evidence of recurrent CSF leak. Conclusion The use of nasal floor mucoperiosteal free grafts in endoscopic surgery offered the advantage of ease of harvest, coverage of large defects, and multiple applications of use, with minimal donor-site morbidity.