Revision Skull Base Reconstruction Using Combined Inferior and Middle Turbinate Flap After Nasoseptal Flap Failure

Abstract

When patients with a history of skull base reconstruction where nasoseptal flap was used require revision surgery, selecting an appropriate flap may be challenging. We report here a successful experience of using combined inferior and middle turbinate flap for revision skull base reconstruction after a nasoseptal flap failure at 22 days postoperatively. A 63-year-old female complaining of right vision loss was referred for co-operation. The patient had undergone transsphenoidal approach (TSA) resection for a pituitary adenoma 20 years ago. Sella turcica MRI showed a recurrent pituitary adenoma of 3.5×5.3-cm in size in the sellar and suprasellar areas, extending to the right cavernous sinus. Endoscopic extended TSA with nasoseptal flap reconstruction was performed for the patient. Flap necrosis followed and flap failure progressed after 10 postoperative days. The patient then underwent a skull base reconstruction using a vascularized inferior turbinate flap and a contralateral middle turbinate flap. Postoperatively, the revision flaps successfully covered the skull base defect without complications.