{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:39:15Z","timestamp":1785929955071,"version":"3.56.0"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005351","name":"Neurosurgery Research and Education Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005351","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Releasing the nasoseptal flap (NSF) pedicle from the sphenopalatine artery (SPA) foramen may considerably improve flap reach and surface area. Our objectives were quantify increases in pedicle length and NSF reach through extended pedicle dissection into the pterygopalatine fossa (PPF) through cadaveric dissections and present clinical applications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Anatomical study and retrospective clinical cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twelve cadaveric dissections were performed. Following standard NSF harvest, the distance from the anterior edge of the flap to the anterior nasal spine while pulling the flap anteriorly was measured. As dissection into the SPA foramen and PPF continued, similar interval measurements were completed in four stages after release from the SPA foramen, release of the internal maxillary artery (IMAX), and transection of the descending palatine artery (DPA). The extended pedicle dissection technique was performed in seven consecutive patients for a variety of different pathologies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean length of the NSF from the anterior nasal spine and maximum flap reach were 1.91 \u00b1 0.40 cm\/9.3 \u00b1 0.39 cm following standard harvest, 2.52 \u00b1 0.61 cm\/9.75\u00b11.06 cm following SPA foramen release, 4.93 \u00b1 0.89 cm\/12.16 \u00b1 0.54 cm following full IMAX dissection, and 6.18 \u00b1 0.68 cm\/13.41 \u00b1 0.75 cm following DPA transection. No flap dehiscence or necrosis was observed in all seven surgical patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Extended pedicle dissection of the NSF to the SPA\/IMAX markedly improves the potential length and reach of the flap. This technique may provide a feasible option for reconstruction of large anterior skull base and craniocervical junction defects. Seven successful cases are presented here, but further studies with larger series are warranted to validate findings in a clinical setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 130:18\u201324, 2020<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27984","type":"journal-article","created":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T13:33:08Z","timestamp":1554125588000},"page":"18-24","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Lengthening the nasoseptal flap pedicle with extended dissection into the pterygopalatine fossa"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5018-0685","authenticated-orcid":false,"given":"Karthik S.","family":"Shastri","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\/Head and Neck Surgery Albany Medical Center  Albany New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano Cesar P. C.","family":"Leonel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Albany Medical Center  Albany New York U.S.A."},{"name":"Department of Surgery Division of Anatomy, University of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\/Head and Neck Surgery Albany Medical Center  Albany New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Charles\u2010Pereira","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\/Head and Neck Surgery Albany Medical Center  Albany New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler J.","family":"Kenning","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Albany Medical Center  Albany New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Peris\u2010Celda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Albany Medical Center  Albany New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos D.","family":"Pinheiro\u2010Neto","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\/Head and Neck Surgery Albany Medical Center  Albany New York U.S.A."},{"name":"Department of Neurosurgery Albany Medical Center  Albany New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000234933.37779.e4"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3378"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24483"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1347368"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21778"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31806db514"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-014-3353-3"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opy075"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1253573"},{"key":"e_1_2_6_11_1","first-page":"741","article-title":"Endoscopic reconstruction skull base using pedicled nasoseptal flap and its anatomy measurements","volume":"27","author":"Cheng F","year":"2013","journal-title":"Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22353"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(98)70262-1"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.27984","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.27984","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.27984","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T19:32:50Z","timestamp":1694201570000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.27984"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1002\/lary.27984"],"URL":"https:\/\/doi.org\/10.1002\/lary.27984","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]},"assertion":[{"value":"2018-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}