Endoscopic Repair of Iatrogenic Cerebrospinal Fluid Rhinorrhea with Osteomucoperiosteal Free Flap Obtained from the Middle Turbinate / 대한이비인후과학회지

ABSTRACT

Iatrogenic cerebrospinal fluid(CSF) rhinorrhea, rarely occuring, is one of the major complications, and should be managed immediately if it occurs during operation. CSF leakage can be repaired intracranially or extracranially. Extracranial approaches are subdivided into extranasal and intranasal. Recent advance in nasal endoscopy and its advantage of low morbidity allow more surgeons to perform the intranasal approach using endoscope. As graft materials, free or rotational flaps of temporalis muscle fascia, muscle, fat, and mucosa or mucoperiosteum in the nasal septum or turbinates have widely been used. Sometimes composite graft such as osteomucoperiosteal(OMP) free flap was also used. By intranal endoscopic approach using OMP free flap obtained from the middle Turbinate(MT), we successfully repaired CSF leakage from a defect, 5~7mm in size, which had occured in the right ethmoid roof near the lamina cribrosa during endoscopic sinus surgery on a patient with chronic paranasal sinusitis. Repair of CSF rhinorrhea using MT OMP free flap may be an useful technique for immediate intraoperative management of the defect, if it is not so large, because of availability and easy handling of this flap in the same surgical field.