J Rhinol.  2018 Nov;25(2):123-129. 10.18787/jr.2018.25.2.123.

Usefulness of Inferior Turbinate Bone-Periosteal-Mucosal Composite Free Graft for Cerebrospinal Fluid Leakage

• Baek K
• Kim J
• Moon Y
• Kim CH
• Yoon JH
• Cho HJ

• KMID: 2431228
• DOI: http://doi.org/10.18787/jr.2018.25.2.123

Abstract

BACKGROUND AND OBJECTIVES
Endoscopic repair of cerebrospinal fluid (CSF) leak can avoid morbidity of open approaches and has shown a favorable success rate. Free mucosal graft is a good method, and multi-layered repair is more favorable. The inferior turbinate has been commonly utilized for the free mucosal graft, but we newly designed it as a bone-periosteal-mucosal composite graft for multilayered reconstruction.
SUBJECTS AND METHOD
Four subjects with a skull base defect were treated with this method. The inferior turbinate was partially resected including the conchal bone and was trimmed according to defect size. Both bony parts and periosteum were preserved on the basolateral side of the mucosa as a composite graft. The graft was applied to the defect site using an overlay technique.
RESULTS
All cases were successfully repaired without any complications. Three of them had a defect size greater than 10-12 mm, and the graft stably repaired the CSF leakage.
CONCLUSIONS
Endoscopic repair of CSF leakage using inferior turbinate composite graft is a simple and easy method and would be favorable for defect sizes greater than 10 mm.

Keyword

Cerebrospinal fluid; Repair; Inferior turbinate; Composite graft

MeSH Terms

Cerebrospinal Fluid Leak*
Cerebrospinal Fluid*
Methods
Mucous Membrane
Periosteum
Skull Base
Transplants*
Turbinates*

Figure

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  Fig. 1 Schematic illustration showing procedures of inferior turbinate bone-periosteum-mucosal composite free graft for skull base defect.

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  Fig. 2 Intraoperative photos of inferior turbinate bone-periosteum-mucosa free graft for skull base defect.

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  Fig. 3 Paranasal sinus coronal CT scan images from the patient of case 1. A: Preoperative image showing bony defect of lateral lamella of cribriform plate. B: Postoperative image showing repaired bony defect using inferior turbinate composite free graft.

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  Fig. 4 Intraoperative photos showing (A) skull base defect & (B) inferior turbinate. POD 8months photos showing (C) skull base defect & (D) inferior turbinate.

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