The Osteo-Mucoperiosteal Flap in Repair of Cerebrospinal Fluid Rhinorrhea: A 20-Year Experience

Abstract

Chronic cerebrospinal fluid rhinorrhea (present for 2 months or longer) is a serious condition frequently encountered by the otolaryngologist–head and neck surgeon. The purpose of this report is that it can be successfully repaired transanally, from below, with a high rate of success. Intracranial repair has been associated with reportedly high morbidity and failure rates. From 1967 to 1987, 16 patients underwent repair of chronic cerebrospinal fluid rhinorrhea in the cribriform plate or fovea ethmoidalis at the University of Iowa with an osteomucoperiosteal flap. Follow-up data from 1.6 to 22 years demonstrated no recurrent leaks in this group of patients. Minimal morbidity and no deaths were associated with the osteomucoperiosteal flap. On the basis of our experience, we recommend this technique, which can be performed by any experienced paranasal sinus surgeon, as superior to craniotomy for the repair of chronic cerebrospinal fluid rhinorrhea from cribriform plate and fovea ethmoidalis defects.