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    Salpingopharyngeus Myomucosal Flap
    (Lippincott Williams & Wilkins, 2014) Gun, Ramazan; Oyama, Kenichi; Kapucu, Burak; Wang, Liang; Al Qahtani, Abdul Aziz; Otto, Bradley A.; Prevedello, Daniel M.
    Objectives: Improvements in the efficacy of extended endonasal approaches to resect skull base pathologies have created the need for new reconstructive alternatives. Hereby, we describe a novel pedicled myomucosal flap that allows the reconstruction of dural defects in the lower clivus and craniovertebral junction or to cover the paraclival and petrous segments of the internal carotid artery. Study Design: Anatomic description. Technical report. Feasibility. Methods: We describe a myomucosal flap with a cephalic pedicle based on the salpingopharyngeus muscle and its vessels. Subsequently, using a cadaveric model, we harvested the flap and explored its potential for the reconstruction of various dural defects or to cover the internal carotid artery. Results: Our study confirmed the feasibility of harvesting and transposing the myomucosal salpingopharyngeus (Dicle flap) flap for the reconstruction of inferior clival and craniovertebral junction defects or to cover the petrous and paraclival segments of the internal carotid artery. Conclusions: The Dicle flap is a feasible, reconstructive alternative for the reconstruction of select small-to medium-sized defects of the posterior and inferior aspects of the ventral skull base.
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    Volumetric Analysis of Nasopharyngectomy via Endoscopic Endonasal, Maxillary Transposition, and Lateral Temporal-Subtemporal Approaches
    (Lippincott Williams & Wilkins, 2015) Kapucu, Burak; Gun, Ramazan; Kirsch, Claudia; Meeks, Darlene; Otto, Bradley A.; Prevedello, Daniel M.; Carrau, Ricardo
    Objective:This project develops a computer model that allows volumetric analysis of the exposure afforded by an endonasal-endoscopic approach, maxillary transposition, and lateral temporal-subtemporal approaches during a nasopharyngectomy. The model will demonstrate idiosyncracies of these approaches, including sacrifice of normal tissues, ease of instrumentation, and gate of entry.Subjects and Methods:Computed tomographic scans of an anatomic specimen were used to create computer simulations of the endoscopic endonasal, maxillary transposition, and lateral temporal-subtemporal approaches for T(1)and T-4 nasopharyngeal carcinoma; therefore, allowing assessment of their surgical corridor using Intuition, a software that allows a semiautomated computerized segmented volumetric analysis.Results:The smallest volumes of tissue mobilization or removal were observed during the endoscopic-endonasal nasopharyngectomy. The volumes of tissue mobilization for the maxillary transposition approach were higher than those of lateral temporal-subtemporal approaches.Conclusions:This model adds to our understanding of select surgical corridors to the nasopharynx. It suggests that an endoscopic-endonasal approach requires less manipulation or resection of smaller volumes of normal tissue to expose a nasopharyngeal tumor than the lateral temporal-subtemporal and maxillary transposition approaches. It also, however, requires instrumentation through a smaller entry gate implying greater difficulty. Nonetheless, these factors should not be construed as superiority of one approach over the other. Factors that are important in the choosing of the surgical approach, such as surgeon's training and experience, invasion of neurovascular structures and method of reconstruction are not considered in this model.