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European Archives of Oto-Rhino-Laryngology
Published in:

31-10-2024 | Incision | Rhinology

Modified salpingopharyngeus myomucosal flap: a novel technique for skull base reconstruction

Authors: Michael Fadel, Mohammad Bilal Alsavaf, Eman H. Salem, Ramazan Gun, Daniel M. Prevedello, Kyle K. Vankoevering, Douglas A. Hardesty, Kathleen Kelly, Ricardo L. Carrau

Published in: European Archives of Oto-Rhino-Laryngology | Issue 1/2025

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Abstract

Purpose

Advancements in endoscopic skull base surgery have enabled complex tumor resections, necessitating a variety of reliable reconstructive techniques to repair resultant defects. Vascularized flaps represent optimal options, but frequently used local pedicled intranasal flaps may be unavailable due to tumor invasion or prior surgery. This study applies a modification to the previously described salpingopharyngeus myomucosal flap (Dicle flap) with potential for its use in extensive endoscopic skull base surgery defect’s repair.

Methods

Cadaveric dissections (n = 5) were performed utilizing endoscopic visualization to access the skull base via endonasal and transoral routes. A superiorly based posterior pharyngeal myomucosal flap along the salpingopharyngeus muscle was elevated off the superior pharyngeal constrictors, preserving their vascular pedicles. This combined flap could be 180 degrees transposed to reconstruct clival defects up to the sella turcica.

Results

The modified salpingopharyngeus myomucosal flap (Modified Dicle flap) provided approximately 40 cm2 of robust vascularized tissue based on the ascending pharyngeal artery and random posterior pharyngeal vessels. It was sufficiently mobilized to cover extensive skull base defects in the craniocervical junction, sella turcica, and protecting the exposed internal carotid artery segments.

Conclusion

The modified Dicle flap offers a viable reconstructive option for extensive endoscopic endonasal skull base defects when commonly utilized vascularized flaps are unavailable. Further research on clinical cases is warranted to investigate postoperative function and refine techniques to minimize donor site morbidity.
Level of evidence: Not applicable.
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Metadata
Title
Modified salpingopharyngeus myomucosal flap: a novel technique for skull base reconstruction
Authors
Michael Fadel
Mohammad Bilal Alsavaf
Eman H. Salem
Ramazan Gun
Daniel M. Prevedello
Kyle K. Vankoevering
Douglas A. Hardesty
Kathleen Kelly
Ricardo L. Carrau
Publication date
31-10-2024
Publisher
Springer Berlin Heidelberg
Keyword
Incision
Published in
European Archives of Oto-Rhino-Laryngology / Issue 1/2025
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-024-09026-9

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