The endonasal endoscopic harvest and anatomy of the buccal fat pad flap for closure of skull base defects

Authors

Jeff Markey, Department of Otolaryngology-Head and Neck Surgery and Department of Neurological Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
Arnau Benet, Department of Otolaryngology-Head and Neck Surgery and Department of Neurological Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
Ivan H. El-Sayed, Department of Otolaryngology-Head and Neck Surgery and Department of Neurological Surgery, University of California-San Francisco, San Francisco, California, U.S.A.

Document Type

Article

Abstract

OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: 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. LEVEL OF EVIDENCE: NA

Medical Subject Headings

Adipose Tissue (anatomy & histology, transplantation); Cadaver; Humans; Skull Base (surgery); Surgical Flaps; Tissue and Organ Harvesting (methods)

Publication Date

10-1-2015

Publication Title

The Laryngoscope

E-ISSN

1531-4995

Volume

125

Issue

10

First Page

2247

Last Page

52

PubMed ID

26053528

Digital Object Identifier (DOI)

10.1002/lary.25209

Recommended Citation

Markey, Jeff; Benet, Arnau; and El-Sayed, Ivan H., "The endonasal endoscopic harvest and anatomy of the buccal fat pad flap for closure of skull base defects" (2015). Neurosurgery. 2147.
https://scholar.barrowneuro.org/neurosurgery/2147