title: Reducing nasal morbidity after skull base reconstruction with the nasoseptal flap: free middle turbinate mucosal grafts.
abstract: OBJECTIVE
  The nasoseptal flap provides hearty vascularized tissue for reconstruction of expanded endonasal approaches (EEA); however, it produces donor site morbidity due to exposed cartilage. Mucosalization of the septum requires 12 weeks, multiple debridements, and frequent saline rinses. This study addresses the reduction of nasal morbidity by grafting middle turbinate mucosa onto the exposed septum.
  
  
  METHODS
  Small prospective study with retrospective analysis of a larger cohort.
  
  
  METHODS
  Fifteen patients undergoing EEA of the ventral skull base were prospectively enrolled. In seven cases, the sacrificed middle turbinate mucosa was harvested and placed as a free mucosal graft on the septal cartilage. In eight controls, middle turbinate grafting was not performed due to tumor involvement. Septal mucosalization and crusting of all patients was quantified at follow-up appointments. An additional 46 patients were retrospectively identified who received middle turbinate grating on their exposed septal cartilage, and mucosalization rates were determined from clinical records.
  
  
  RESULTS
  Three weeks after initial operation, the mucosalization rate was 70% versus 5% in the graft and nongraft groups, respectively. At postoperative week 6, the mucosalization and crusting were 97% and 5% for the graft group versus 60% and 85% for the nongraft group. Mucosalization rates in the retrospective graft series agreed with the prospective series.
  
  
  CONCLUSIONS
  Despite donor site morbidity, the nasoseptal flap is becoming the standard of care for skull base reconstruction due to its reliability in reestablishing a barrier between the subarachnoid space and the sinonasal tract. It is possible to dramatically increase the rate of septal mucosalization and decrease crusting by using a middle turbinate free mucosal graft.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kimple
authors.forename: W Derek
authors.initials: WD
authors.lastname: Leight
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wheless
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zanation
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D009297:Nasal Mucosa / Q000637:transplantation; D009300:Nasal Septum / Q000601:surgery / Q000637:transplantation*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D020858:Tissue and Organ Harvesting; D014420:Turbinates / Q000601:surgery / Q000637:transplantation