Anatomical basis of the elongated nasoseptal flap| ACTA Otorhinolaryngologica Italica

Abstract

Objective

This study aimed to elucidate the anatomical factors influencing elongation of the pedicle of the nasoseptal flap.

Methods

Dissections were conducted on tissue blocks taken from a total of 62 half heads from embalmed cadavers. 36 were dissected with a 2.5x binocular dissecting microscope to delineate the configuration of the third part of the maxillary artery. 22 specimens were dissected using endoscopic instruments to elucidate the tethering points hindering the mobility of the pedicle of the nasoseptal flap and to investigate the surgical manoeuvres required for release.

Results

The maxillary artery coils to a variable degree in the pterygopalatine fossa. Up to 4.7 +/- 0.5cm of nasoseptal pedicle elongation is possible in the more common double looped forms. Elongation is limited to 2.6 +/- 0.5cm in the single loop form found in almost 1/5th of specimens (19.2%). GPA transection is more important for pedicle elongation in the single loop form. Posterior branches such as the Vidian artery and pharyngeal artery may hinder pedicle elongation particularly if they have a ‘late’ origin from the maxillary/ sphenopalatine artery.

Conclusions

The pedicle of the nasoseptal flap may be elongated by up to 4.7 +/- 0.5cm potentially increasing its utility. The extent of maxillary artery looping determines the vessel length available for elongation whilst the branch configuration particularly the origins of the palatine arteries and the posterior branches such as the Vidian artery and pharyngeal artery determine how difficult the process would be.