How I do it. The pedicled temporoparietal fascia flap for skull base reconstruction after endonasal endoscopic approaches
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Endoscopic endonasal approaches (EEA) are an alternative for removing challenging nasopharyngeal or skull base lesions. In some cases, a nasoseptal flap (NSF) is not always available and such complex procedures may lead to carotid arteries exposition and/or dura mater (DM) wide opening. Meticulous carotid coverage and DM reconstruction are crucial for preventing early and delayed complications.
We propose a step-by-step description of the pedicled temporoparietal fascia flap (TPFF) technique, with a focus on its pitfalls, advantages and limits.
The TPFF is a reliable flap for skull base reconstruction when other pedicled flaps are not available.
1. Reliable flap even for irradiated patients
2. CT angiography with 3D reconstruction as pre-operative imaging
3. Doppler ultrasound probe to draw the artery’s trajectory on skin
4. TPFF elevation concomitantly to the endoscopic procedure
5. Hemicoronal incision sufficient to harvest the TPFF
6. Superficial dissection in a plane just beneath the hair follicles
7. Dissection plane deep to the fad pad to preserve the frontal branch of the facial nerve
8. Surgical corridor wide enough to avoid any compression of the pedicle
9. Double visualization to avoid any twist and Doppler control of the STA patency
10. Close follow-up, toilet in clinics
KeywordsEndoscopic surgery Skull base Temporoparietal fascia flap Dural defects Nasopharyngectomy Radiotherapy Reconstruction
Compliance with ethical standards
Disclosure - Conflict of interest
No sponsorships or competing interests have been disclosed for this article.
Step by step TPFF technique: coverage of a “type 3” rhinopharyngectomy performed for a recurrent nasopharyngeal carcinoma (left side) in a 25-year-old woman. (MOV 324810 kb)
- 1.Fortes FS, Carrau RL, Snyderman CH, Kassam A, Prevedello D, Vescan A, Mintz A, Gardner P (2007) Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. The Laryngoscope 117:970–976CrossRefPubMedGoogle Scholar