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Volume 12 Issue 6
Nov.  2021
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Article Navigation >  Medical Journal of Peking Union Medical College Hospital  > 2021  >  12(6): 922-932
ZHU Zhihui, HOU Yingzi, ZHAO Ruiqi, WU Limeng, LEI Zhenghui, FENG Guodong, GAO Zhiqiang, ZHANG Tao. Analysis and Summary: Reconstructive Methods of Lateral Skull Base Defects after Radical Tumor Resection in 62 Cases[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(6): 922-932. doi: 10.12290/xhyxzz.2021-0565
Citation: ZHU Zhihui, HOU Yingzi, ZHAO Ruiqi, WU Limeng, LEI Zhenghui, FENG Guodong, GAO Zhiqiang, ZHANG Tao. Analysis and Summary: Reconstructive Methods of Lateral Skull Base Defects after Radical Tumor Resection in 62 Cases[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(6): 922-932. doi: 10.12290/xhyxzz.2021-0565
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Analysis and Summary: Reconstructive Methods of Lateral Skull Base Defects after Radical Tumor Resection in 62 Cases

doi: 10.12290/xhyxzz.2021-0565
  • 1.

    Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 3.

    Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Stomatology, Beijing Zhongguancun Hospital, Beijing 100083, China

Funds:

Capital's Funds for Health Improvement and Research 2020-2Z-40116

Beijing Natural Science Foundation L182066

More Information
  • Corresponding author: ZHANG Tao  Tel: 86-10-69156335, E-mail: drtzhang@126.com
  • Received Date: 2021-07-30
  • Accepted Date: 2021-10-20
  • Publish Date: 2021-11-30
    Abstract
  •   Objective  To explore the methods for the reconstruction of lateral skull base defects after radical tumor resection.  Methods  Patients who underwent lateral skull base radical tumor resection and reconstruction from January 1, 2012 to December 31, 2019 in the Department of Stomatology and Otorhinolaryngology in Peking Union Medical College Hospital, were enrolled in this retrospective study. These patients were divided into three subgroups depending on the type of defects. Group I, patients without skin defects; Group Ⅱ, patients with skin defects; Group Ⅲ, patients with larger jaw defects. Different reconstructive methods were applied for the three groups.  Results  Sixty-two patients (63 procedures of defect repair) were enrolled in this study. The survival rate of tissue flap was 98.41%(62/63), and the primary wound healing rate was 90.48% (57/63). There were 34 patients in Group I. Among them, 6 cases received free fat transplantation; 14 cases were repaired with fat transplantation combined with local flaps; 13 cases were repaired with sternocleidomastoid muscle flap or combined temporal muscle flap; 1 case was repaired with temporal muscle flap combined with submandibular gland flap. Among them, two patients had postoperative cerebrospinal fluid leakage and delayed healing after dressing change. All patients had no postoperative infection and fat liquefaction, and the wounds healed by primary intention. The survival rate of tissue flap was 100%, and 94.12% (32/34) of the wounds healed by primary intention. There were 23 patients in Group Ⅱ. Five patients whose skin defects were less than 3 cm were reconstructed with local tissue flaps combined with advancement flaps; all flaps survived completely and the wounds healed by primary intention. The survival rate of tissue flap was 100%, and the primary wound healing rate was 100%. For those skin defects greater than 3 cm, free anterolateral thigh flaps were applied in 8 patients, pedicle flaps such as pectoralis flaps in 6 patients, 2 cases used forearm flap combined with pedicle skin flap or local tissue flap, 2 cases had pectoralis major myocutaneous flap or combined cervical and facial propulsion skin flap and submandibular gland flap, 1 case had rectus abdominis skin flap. One of the patients who had undergone high-dose radiotherapy developed venous embolism 3 days after repair with the anterolateral thigh myocutaneous flap, which was later repaired with pectoralis major myocutaneous flap rescue, and the remaining flaps survived completely; 1 patient with anterolateral thigh flap transplantation developed recipient hematoma on the second postoperative day, and the wound recovered after hematoma evacuation. One patient with rectus abdominis muscle repair developed cerebrospinal fluid leakage after surgery, and the skin lesions had delayed healing after dressing change. Two cases were repaired with pectoralis major myocutaneous flap and other pedicle skin flaps, and there was a small area of necrosis at the distal end. The wounds had delayed healing after dressing change. The wounds of the remaining patients healed at first stage; the first-stage wound-healing rate was 84.21% (16/19), and the flap survival rate was 94.74%(18/19). There were 5 patients in Group Ⅲ; 2 cases were reconstructed with fibular flap; 2 cases were reconstructed with free rib graft combined with temporal flap; 1 patient underwent femur-anterolateral thigh osteomyocutaneous free flap reconstruction. There were 10 patients whose tumors invaded the bones of the skull base and caused intracranial and external communication after surgery. Seven of them had no postoperative complications, and the remaining three had post-operative cerebrospinal fluid leakage, which delayed healing after dressing changes. There were 24 patients received simultaneous facial nerve reconstruction, including 12 cases reconstructed with greater auricular nerve transplantation, 8 cases with hypoglossal nerve, 3 cases with masseter nerve (+/-) greater auricular nerve, and 1 case with lateral femoral cutaneous nerve. Thirteen patients were followed up, and all had varying degrees of recovery of facial nerve function.  Conclusions  Different reconstruction regimens should be taken according to different types of defects after radical tumor resection. The patients without skin defects can be reconstructed with the temporal muscle flap combined with autologous fat grafting or local tissue flaps. The patients with skin defects smaller than 3 cm can be reconstructed with the cervicofacial advancement flap combined with local tissue flaps. The most reliable free flap for lateral skull base reconstruction is the anterolateral thigh flap for the patients with skin defects larger than 3 cm. For those patients who were not suitable for microsurgical reconstructive operation, the pectoralis major muscle flap repair should be selected. If the defect is above the zygomatic arch, it is better to choose the pectoralis major muscle flap combined with cervicofacial advancement flap or local tissue flaps. The bone defect should be reconstructed appropriately if the patients presented with a large jaw defect. If conditions permit, the facial nerve defect reconstruction should be applied simultaneously.
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    • References(28)
  • [1] Kumar FA, Valvassori G, Mafee M, et al. Skull base lesions: a classification and surgical approaches[J]. Laryngoscope, 2010, 96: 252-263. http://www.onacademic.com/detail/journal_1000035200139010_91b7.html
    [2] Moncrieff MD, Hamilton SA, Lamberty GH, et al. Reconstructive options after temporal bone resection for squamous cell carcinoma[J]. J Plast Reconstr Aesthet Surg, 2007, 60: 607-614. doi:  10.1016/j.bjps.2006.11.005
    [3] Iseli TA, Harris G, Dean NR, et al. Outcomes of static and dynamic facial nerve repair in head and neck cancer[J]. Laryngoscope, 2010, 120: 478-483. doi:  10.1002/lary.20789
    [4] 邱尉六. 口腔颌面外科理论与实践[M]. 北京: 人民卫生出版社, 1998: 1031-1051.
    [5] House JW, Brackmann DE. Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985, 93: 146-147. doi:  10.1177/019459988509300202
    [6] Tamplen M, Knott PD, Fritz MA, et al. Controversies in parotid defect reconstruction[J]. Facial Plast Surg Clin North Am, 2016, 24: 235-243. doi:  10.1016/j.fsc.2016.03.002
    [7] Dean NR, White HN, Carter DS, et al. Outcomes following temporal bone resection[J]. Laryngoscope, 2010, 120: 1516-1522. doi:  10.1002/lary.20999
    [8] 陈立, 吴皓, 黄琦, 等. 侧颅底肿瘤切除术后缺损的修复重建[J]. 临床耳鼻咽喉头颈外科杂志, 2009, 23: 433-435. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH200910003.htm

    Chen L, Wu H, Huang Q, et al. Defect reconstruction after removal of tumor in lateral skull base[J]. Linchuang Erbi Yanhou Toujing Waike Zazhi, 2009, 23: 433-435. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH200910003.htm
    [9] Richmon JD, Yarlagadda BB, Wax MK, et al. Locoregional and free flap reconstruction of the lateral skull base[J]. Head Neck, 2015, 37: 1387-1391. doi:  10.1002/hed.23725
    [10] Caitlin B, Changxing L, Niels K. Reconstruction of parotidectomy and lateral skull base defects[J]. Curr Opin Otolaryngol Head Neck Surg, 2017, 25: 431-438. doi:  10.1097/MOO.0000000000000391
    [11] Patel R, Buchmann LO, Hunt J. The use of the temporoparietal fascial flap in preventing CSF leak after lateral skull base surgery[J]. J Neurol Surg B Skull Base, 2013, 74: 311-316. doi:  10.1055/s-0033-1349059
    [12] Irvine LE, Larian B, Azizzadeh B. Locoregional parotid reconstruction[J]. Otolaryngol Clin North Am, 2016, 49: 435-446. doi:  10.1016/j.otc.2015.10.012
    [13] 刘全, 孙希才, 王欢, 等. 颞肌瓣鼻颅底区转位的解剖[J]. 解剖学报, 2020, 51: 659-663. https://www.cnki.com.cn/Article/CJFDTOTAL-JPXB202005006.htm

    Liu Q, Sun XC, Wang H, et al. Anatomy of transposition of the temporalis muscle flap for skull base reconstruction[J]. Jiepou Xuebao, 2020, 51: 659-663. https://www.cnki.com.cn/Article/CJFDTOTAL-JPXB202005006.htm
    [14] Liu H, Li Y, Dai X. Modified face-lift approach combined with a superficially anterior and superior-based sternocleidomastoid muscle flap in total parotidectomy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113: 593-599. doi:  10.1016/j.tripleo.2011.04.042
    [15] Liu FY, Xu ZF, Li P, et al. The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery[J]. World J Surg Oncol, 2011, 9: 135. doi:  10.1186/1477-7819-9-135
    [16] Thompson NJ, Roche JP, Schularick NM, et al. Reconstruction outcomes following lateral skull base resection[J]. Otol Neurotol, 2016, 38: 264-271. http://www.ncbi.nlm.nih.gov/pubmed/27832006
    [17] Arnaoutakis D, Kadakia S, Abraham M, et al. Locoregional and Microvascular Free Tissue Reconstruction of the Lateral Skull Base[J]. Semin Plast Surg, 2017, 31: 197-202. doi:  10.1055/s-0037-1606556
    [18] O'Connell DA, Teng MS, Mendez E, et al. Microvascular free tissue transfer in the reconstruction of scalp and lateral temporal bone defects[J]. J Craniofac Surg, 2011, 22: 801-804. doi:  10.1097/SCS.0b013e31820f3730
    [19] Malata CM, Tehrani H, Kumiponjera D, et al. Use of Anterolateral Thigh and Lateral Arm Fasciocutaneous Free Flaps in Lateral Skull Base Reconstruction[J]. Ann Plast Surg, 2006, 57: 169-175. doi:  10.1097/01.sap.0000218490.16921.c2
    [20] Trojanowski P, Szymański M, Trojanowska A, et al. Anterolateral thigh free fap in reconstruction of lateral skull base defects after oncological resection[J]. Eur Arch Otorhinolaryngol, 2019, 276: 3487-3494. doi:  10.1007/s00405-019-05627-x
    [21] Camporro D, Fueyo A, Martín C, et al. Use of lateral circumflex femoral artery system free flaps in skull base reconstruction[J]. J Craniofac Surg, 2011, 22: 888-893. doi:  10.1097/SCS.0b013e3182139cae
    [22] Homer JJ, Lesser T, Moffat D, et al. Management of lateral skull base cancer: United Kingdom National Multidisciplinary Guidelines[J]. J Laryngol Otol, 2016, 130: S119-S124. http://www.onacademic.com/detail/journal_1000038876220110_d399.html
    [23] Trojanowski P, Szymański M, Trojanowska A, et al. Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection[J]. Eur Arch Otorhinolaryngol, 2019, 276: 3487-3494. doi:  10.1007/s00405-019-05627-x
    [24] Trainotti S, Hoffmann TK, Rotter N, et al. Pectoralis Major Muscle Free Flap: Anatomical Studies on Pedicle Length and Vessel Diameter[J]. Ear Nose Throat J, 2019, 98: 431-434. doi:  10.1177/0145561319840821
    [25] Moore BA, Wine T, Netterville JL. Cervicofacial and cervicothoracic rotation flaps in head and neck reconstruction[J]. Head Neck, 2005, 27: 1092-1101. doi:  10.1002/hed.20252
    [26] Rosenthal EL, King T, McGrew BM, et al. Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects[J]. Head Neck, 2008, 30: 589-594. doi:  10.1002/hed.20744
    [27] Zhang XH, Meng FH, Zhu ZH. Anatomic study of the femur-vastus intermedius muscle-anterolateral thigh osteomyocutaneous free flap[J]. J Plast Reconstr Aesthet Surg, 2021, 74: 1508-1514. doi:  10.1016/j.bjps.2020.12.001
    [28] Yla-Kotola T, Goldstein DP, Hofer SO, et al. Facial nerve reconstruction and facial disfigurement after radical parotidectomy[J]. J Reconstr Microsurg, 2015, 31: 313-318. doi:  10.1055/s-0035-1544227
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