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P066: COMPARISON OF TWO NOVEL TECHNIQUES FOR RESUSPENSION OF INVERTED U-SHAPED NASOPHARYNGEAL FLAP FOLLOWING ENDONASAL ACCESS TO CRANIO-VERTEBRAL JUNCTION: CADAVERIC ANALYSIS
Beatrice Zucca, MS¹; Marissa Koscielski, MS²; Jeff Zhang, MD¹; John Na, MS²; Andrea De Gregorio, MS³; Ian Smith, MS¹; Joel Kaye, MD¹; Ahmad Sedaghat, MD⁴; Samer Hoz, MD¹; Charles Prestigiacomo, MD¹; Rani Nasser, MD¹; Justin Virojanapa, MD¹; Norberto Andaluz, MD¹; Katie Phillips, MD⁴; Jonhatan Forbes, MD¹; ¹Department of Neurological Surgery, University of Cincinnati Medical Center, Cincinnati, OH; ²University of Cincinnati College of Medicine, Cincinnati, OH; ³University of Milan, Milan, Italy; ⁴Otolaryngology - Head and Nek Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

Backgrounds: Suturing in the narrow endonasal corridor can be technically challenging. However, for some endonasal procedures, such as inverted U-shaped nasopharyngeal flap (IUNF) exposure of the cranio-cervical junction (CVJ), flap resuspension offers clinical utility. Despite surgical limitations, two novel suturing techniques demostrate promise: (1) use of barbed Stratafix suture and (2) use of the Durastat dural repair device, which obviate the need for knot tying and endonasal needle driver supination, respectively.

Objectives: To assess the feasibility of IUNF resuspension using two novel techniques: (1) running mucosal suturing using endonasal needle driver and barbed, loop suture (Fig.A) and (2) interrupted mucosal resuspension using the Durastat device in three cadaveric heads (Fig. B).

Methods: In 3 specimens, an IUNF was created with a superior incision just below the pharyngeal tubercle of the clivus and lateral incisions at the approximate location of Rosenmuller’s fossa bilaterally, exposing the CVJ. The IUNF was subsequently resuspended using a 3-0 monocryl barbed Stratafix and an endonasal needle driver. After Stratafix suture removal, resuspension was performed using interrupted sutures with the Durastat device. Repair time was measured objectively, and suture line precision was subjectively evaluated.

Results: Optimal quality of IUNF repair was achieved with both methods (3/3). The barbed suture required more procedural time on average (18.98 minutes), as compared to the Durastat system (18.58 minutes). The average time associated with Durastat repair was thought to be artificially inflated secondary to multiple instances of the smaller needle unsuccessfully puncturing the mucosal flap using the spring mechanism alone, suggesting improvements in size and curvature of the needle may optimize performance in the future.

Conclusion: Adequate mucosal resuspension was successfully achieved in all specimens. Stratafix offered greater consistency with needle puncture and similar precision but was thought to be more technically challenging compared to the Durastat system. With appropriate technological modifications, the authors believe the Durastat system has great potential to optimize IUNF resuspension

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