Use of acoustic Doppler sonography to ascertain the feasibility of the pedicled nasoseptal flap after prior bilateral sphenoidotomy.
OBJECTIVE
Blood supply to the Hadad-Bassagasteguy pedicled nasoseptal flap may be interrupted by surgery of the pterygopalatine fossa, posterior septectomy, or large sphenoidotomies. This would preclude its use for reconstruction of skull base defects after expanded endonasal approaches (EEA). We present a novel method to ascertain the patency of the nasoseptal artery after prior surgery, and consequently the availability of the nasoseptal flap, using acoustic Doppler sonography.


METHODS
Retrospective clinical review.


METHODS
Four patients who underwent EEAs were evaluated intraoperatively with acoustic Doppler sonography. The mucosa that covers the inferior aspect of the rostrum of the sphenoid sinus was scanned with the tip of the probe. Reflection of sound waves representing intravascular blood flow was assessed.


RESULTS
In three patients, the artery was identified in at least one side. One remaining patient showed no acoustic signal suggesting loss of the nasoseptal artery bilaterally, therefore necessitating the use of a fat graft for the reconstruction.


CONCLUSIONS
Acoustic Doppler sonography seems to be a feasible and effective way to ascertain the availability of the nasoseptal artery. It is a relatively inexpensive and simple technique that can be performed by any endoscopic surgeon.
Pinheiro-Neto
Carlos D
CD
Department of Otolaryngology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Carrau
Ricardo L
RL
Prevedello
Daniel M
DM
Fernandez-Miranda
Juan C
JC
Snyderman
Carl S
CS
Gardner
Paul A
PA
Kassam
Amin B
AB
D000236:Adenoma / Q000601:surgery*; D000328:Adult; D002817:Chordoma / Q000601:surgery*; D003397:Craniopharyngioma / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008833:Microcirculation / Q000502:physiology; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D012039:Regional Blood Flow / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D018608:Ultrasonography, Doppler; D014654:Vascular Patency / Q000502:physiology*