Mucocele rate after endoscopic skull base reconstruction using vascularized pedicled flaps. 2011

Benjamin S Bleier, and Eric W Wang, and W Alex Vandergrift, and Rodney J Schlosser
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. bleierb@gmail.com

BACKGROUND Postoperative cerebrospinal fluid leak is a significant risk after endoscopic skull base surgery. Recently, novel reconstructive techniques using vascularized pedicled mucosal flaps have been applied to decrease this potential risk. Complete mucosal extirpation in the wound bed is not always feasible and the impact of insetting the flap over intact underlying mucosa is not clear. The purpose of this study was to determine the rate of mucocele formation after nasoseptal flap reconstruction without mucosal stripping. METHODS This is an Institutional Review Board-approved, retrospective study consisting of 28 patients undergoing skull base reconstruction using a pedicled nasoseptal flap between 2008 and 2010 at a tertiary care hospital. In all cases the sinus or skull base mucosa surrounding the defect was left intact. Patients were followed postoperatively by endoscopy and/or imaging for evidence of mucocele formation in the reconstructive bed. RESULTS The total rate of mucocele formation was 3.6% (1 of 28, noted on postoperative day 46). The mean follow-up time was 243 ± 174 days (range, 46-585 days). Eleven patients were followed for over 1 year. All flaps remained viable and well vascularized. CONCLUSIONS The pedicled nasoseptal flap is an effective means of reconstruction after endoscopic skull base surgery. Avoidance of extensive stripping of the surrounding mucosa does not result in a significant rate of postoperative mucocele formation in the short term. Long-term follow-up is still indicated.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009078 Mucocele A retention cyst of the salivary gland, lacrimal sac, paranasal sinuses, appendix, or gallbladder. (Stedman, 26th ed) Mucoceles
D009092 Mucous Membrane An EPITHELIUM with MUCUS-secreting cells, such as GOBLET CELLS. It forms the lining of many body cavities, such as the DIGESTIVE TRACT, the RESPIRATORY TRACT, and the reproductive tract. Mucosa, rich in blood and lymph vessels, comprises an inner epithelium, a middle layer (lamina propria) of loose CONNECTIVE TISSUE, and an outer layer (muscularis mucosae) of SMOOTH MUSCLE CELLS that separates the mucosa from submucosa. Lamina Propria,Mucosa,Mucosal Tissue,Muscularis Mucosae,Mucous Membranes,Membrane, Mucous,Membranes, Mucous,Mucosae, Muscularis,Mucosal Tissues,Propria, Lamina,Tissue, Mucosal,Tissues, Mucosal
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D002559 Cerebrospinal Fluid Rhinorrhea Discharge of cerebrospinal fluid through the nose. Common etiologies include trauma, neoplasms, and prior surgery, although the condition may occur spontaneously. (Otolaryngol Head Neck Surg 1997 Apr;116(4):442-9) Cerebrospinal Rhinorrhea,CSF Rhinorrhea,Cerebrospinal Fluid Rhinorrhea, Post-Traumatic,Cerebrospinal Fluid Rhinorrhea, Spontaneous,Cerebrospinal Fluid Rhinorrhea, Traumatic,Post-Traumatic Cerebrospinal Fluid Rhinorrhea,Post-Traumatic Rhinorrhea, Cerebrospinal Fluid,Rhinorrhea, Cerebrospinal Fluid, Post-Traumatic,Rhinorrhea, Cerebrospinal Fluid, Spontaneous,Rhinorrhea, Cerebrospinal Fluid, Traumatic,Rhinorrhea, Post-Traumatic, Cerebrospinal Fluid,Rhinorrhea, Spontaneous Cerebrospinal Fluid,Rhinorrhea, Traumatic Cerebrospinal Fluid,Spontaneous Cerebrospinal Fluid Rhinorrhea,Spontaneous Rhinorrhea, Cerebrospinal Fluid,Traumatic Cerebrospinal Fluid Rhinorrhea,Traumatic Rhinorrhea, Cerebrospinal Fluid,CSF Rhinorrheas,Cerebrospinal Fluid Rhinorrhea, Post Traumatic,Cerebrospinal Fluid Rhinorrheas,Cerebrospinal Rhinorrheas,Post Traumatic Cerebrospinal Fluid Rhinorrhea,Post Traumatic Rhinorrhea, Cerebrospinal Fluid,Rhinorrhea, CSF,Rhinorrhea, Cerebrospinal,Rhinorrhea, Cerebrospinal Fluid,Rhinorrheas, CSF,Rhinorrheas, Cerebrospinal,Rhinorrheas, Cerebrospinal Fluid
D003952 Diagnostic Imaging Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. Imaging, Diagnostic,Imaging, Medical,Medical Imaging
D004724 Endoscopy Procedures of applying ENDOSCOPES for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. transluminal, to examine or perform surgery on the interior parts of the body. Endoscopic Surgical Procedures,Surgical Procedures, Endoscopic,Endoscopic Surgical Procedure,Endoscopy, Surgical,Surgical Endoscopy,Surgical Procedure, Endoscopic,Procedure, Endoscopic Surgical,Procedures, Endoscopic Surgical
D005260 Female Females
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup

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