title: The endonasal endoscopic harvest and anatomy of the buccal fat pad flap for closure of skull base defects.
abstract: OBJECTIVE
  Extirpation via expanded endonasal approaches (EEA) to the skull base can result in defects requiring vascularized rotational flap reconstruction. The buccal fat pad (BFP) is a vascularized graft described in open skull base resections, but its harvest and adequacy of vascular supply have not been examined for use with EEA.
  
  
  METHODS
  A transfacial cadaveric dissection was carried forth in a latex-injected specimen to characterize the BFP blood supply. Then a cadaveric dissection series was performed involving the endoscopic harvest and rotation of 10 buccal fat pads in five cadaveric specimens to assess defect coverage.
  
  
  METHODS
  An endoscopic medial maxillectomy combined with an anterior maxillotomy was performed prior to endoscopic harvest in cadaveric specimens. The BFP was rotated to assess its capability to reconstruct seven possible ventral skull base defects. Finally, the BFP vascular anatomy was further characterized following harvest and transposition.
  
  
  RESULTS
  The BFP reconstructed defects at the greater sphenoid wing, inferior and superior clivus, sella, planum, and bilateral ethmoids in all cadaveric specimens. In some cases it covered two sites concurrently.
  
  
  CONCLUSIONS
  The BFP pedicled rotational flap is a potential alternate flap following EEA in select cases.
  
  
  METHODS
  NA
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Department of Neurological Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
authors.forename: Jeff
authors.initials: J
authors.lastname: Markey
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Department of Neurological Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
authors.forename: Arnau
authors.initials: A
authors.lastname: Benet
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Department of Neurological Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
authors.forename: Ivan H
authors.initials: IH
authors.lastname: El-Sayed
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology* / Q000637:transplantation*; D002102:Cadaver; D006801:Humans; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting / Q000379:methods*
keywords: Cranial base, skull base, nonmicrovascular reconstruction, reconstructive surgery, facial plastics