The turbinal flap: an additional option for anterior skull base reconstruction. Cadaveric feasibility study and case report
Bibliographic record
Abstract
Background Over the past decade, the treatment of complex intradural and extradural pathologies via expanded endonasal approaches has been made possible by progresses and refinements in skull base reconstruction techniques. The aim of this anatomic study is to describe a novel endonasal flap, the turbinal flap (TF), based on the middle and superior turbinate mucosa and pedicled on the ethmoidal arteries system. Methods Three fresh‐frozen (6 sides) cadaver heads previously injected with colored silicone were dissected. A step‐by‐step description of the surgical technique is provided. Vascularization of the TF and its range of possibilities to cover anterior skull base defects were studied. Flap dimensions and area were measured. A case report where the TF was successfully used is also described. Results The TF was adequate to repair defects along the entire ethmoid roof. Its pedicle along the skull base was 3.0 cm in length and sagittally oriented. Mean measures of the TF were 3.4 cm (anterior height), 5.5 cm (posterior height), and 4.8 cm (inferior length). Its mean area was 8.6 cm2. The flap was supplied by rich network of vessels. A demonstrative case of anterior skull base repair after the endoscopic resection of meningocephalocele of the ethmoid roof is reported. Conclusion The main indication for the TF is the repair of anterior skull base defects involving the ethmoid roof. Its advantages include the double pedicle, rich vascularization, autonomy from the maxillary artery system, and preservation of the olfactory mucosa.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".