Vascularized middle turbinate mucoperiosteal flap in skull base defects: follow-up analysis of 20 cases


  • Shibu George Department of ENT, Government Medical College, Kottayam, Kerala, India
  • Sandeep Suresh Department of ENT, Government Medical College, Kottayam, Kerala, India



Surgical flaps, Pedicled flap, Turbinates, Skull base, Cerebrospinal fluid rhinorrhea


Background: Vascularized flaps are preferred in repair of skull base defects since they provide quality tissue volume and allow rapid healing. Though nasoseptal flap is the gold standard it may not be available always and has its own share of pitfalls; this makes the middle turbinate flap a viable alternative. This descriptive study was designed to analyze the efficacy of middle turbinate flap in endoscopic closure of skull base defects and to define indications and limitations of the flap.

Methods: 20 patients who underwent endoscopic closure of small and medium sized skull base defects using middle turbinate mucoperiosteal flap were analyzed and followed up. Etiology, presentation, site and co-morbidities associated with such defects were studied. Effectiveness of closure was analyzed by the ability to cover fully, graft uptake and complications.  

Results: Successful flap take up was noted in all 20 cases (100%) on long term follow up; transient cerebrospinal fluid leak was observed in 1case (5%) during the immediate post-operative period which subsided fully. Spontaneous CSF rhinorrhea (n=11 [55%]) was the most common indication for closure and unilateral watery rhinorrhea was the commonest presentation (n=13 [65%]). Benign intracranial hypertension was found to have significant association with cerebrospinal fluid rhinorrhea. Most common site of leak was the medial lamella of cribriform plate (n=11 [55%]).

Conclusions: Middle turbinate flap is an effective alternative to nasoseptal flap for small and medium sized anterior skull base defects; efficacy in larger defects and posterior sellar defects cannot be substantiated. 

Author Biographies

Shibu George, Department of ENT, Government Medical College, Kottayam, Kerala, India

Additional Professor

Department of ENT

Sandeep Suresh, Department of ENT, Government Medical College, Kottayam, Kerala, India

ENT consultant


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Original Research Articles