{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T02:12:58Z","timestamp":1781921578084,"version":"3.54.5"},"reference-count":17,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Although the Hadad\u2010Bassagusteguy flap represents the first choice for middle and posterior skull base reconstruction and coverage of exposed bony areas, in some cases it is unavailable. The aim of this study is to describe, as an alternative option in selected cases, a modified posterior pedicle middle turbinate flap (mPPMTF) extended to the lacrimal area. Anatomical features, step\u2010by\u2010step harvesting technique, and surgical applications are presented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Anatomic dissection study and case report.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four mPPMTFs were raised in two fresh\u2010frozen cadaver heads. A study of the vascular supply and measurements of length, width, and area of the flap were performed. The ability of the flap to cover the ventral skull base, particularly the upper clivus area, was tested. A clinical case in which an mPPMTF was used for clivus resurfacing after osteoradionecrosis is reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The vascular supply of the mPPMTF was identified as the middle turbinate branch of the sphenopalatine artery. The flap had a mean length of 6.92\u2009cm, mean maximum width of 1.08\u2009cm, and mean total area of 5.33\u2009cm<jats:sup>2<\/jats:sup>. The flap was able to reach the upper clivus, with a clival coverage ratio of 70.66%. In the clinical case, good surgical outcomes were observed, with accelerated re\u2010epithelization without complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The mPPMTF represents an alternative to the Hadad\u2010Bassagusteguy flap for posterior cranial fossa and nasopharynx resurfacing. The main drawbacks are its technically demanding and time\u2010consuming harvesting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 131:E767\u2013E774, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29099","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T22:02:29Z","timestamp":1601330549000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Modified Posterior Pedicle Middle Turbinate Flap: An Additional Option for Skull Base Resurfacing"],"prefix":"10.1002","volume":"131","author":[{"given":"Andrea","family":"Pistochini","sequence":"first","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Surgical Specialties ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2315-1939","authenticated-orcid":false,"given":"Federico","family":"Russo","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences University of Insubria\u2013Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0382-7137","authenticated-orcid":false,"given":"Elisa","family":"Coden","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences University of Insubria\u2013Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Sileo","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences University of Insubria\u2013Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Battaglia","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences University of Insubria\u2013Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"},{"name":"Department of Biotechnology and Life Sciences, Head and Neck Surgery and Forensic Dissection Research Center University of Insubria  Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Bignami","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences University of Insubria\u2013Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"},{"name":"Department of Biotechnology and Life Sciences, Head and Neck Surgery and Forensic Dissection Research Center University of Insubria  Varese Italy"},{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Ospedale Sant'Anna, San Fermo della Battaglia  Como Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Volpi","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Surgical Specialties ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5184-6140","authenticated-orcid":false,"given":"Paolo","family":"Castelnuovo","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences University of Insubria\u2013Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi  Varese Italy"},{"name":"Department of Biotechnology and Life Sciences, Head and Neck 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