Free Tissue Transfer for Central Skull Base Defect Reconstruction: Case Series and Surgical Technique

Authors

S. Hamad Sagheer, Thomas Jefferson UniversityFollow
Brian Swendseid, Thomas Jefferson UniversityFollow
James Evans, Thomas Jefferson UniversityFollow
Mindy Rabinowitz, Thomas Jefferson UniversityFollow
Gurston Nyquist, Thomas Jefferson UniversityFollow
Marc R. Rosen, Thomas Jefferson UniversityFollow
Elina Toskala, Thomas Jefferson UniversityFollow
Ryan Heffelfinger, Thomas Jefferson UniversityFollow
Adam J. Luginbuhl, Thomas Jefferson UniversityFollow
Joseph M. Curry, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

2-13-2021

Comments

This article is the author’s final published version in Oral Oncology, Volume 115, April 2021, Article number 105220.

The published version is available at https://doi.org/10.1016/j.oraloncology.2021.105220. Copyright © Sagheer et al.

Abstract

Objectives: Local reconstruction of central skull base defects may be inadequate for large defects or reoperative cases; free tissue transfer may be necessary. Inset of the flap and management of the pedicle can be challenging. We report our experience and approach.

Methods: Retrospective review identifying seven patients with central skull base defects who underwent free flap reconstruction from 2016-2020.

Results: Four patients with recurrent nasopharyngeal carcinoma, one with recurrent craniopharyngioma, one with clival-cervical chordoma, and one with meningioma of the middle cranial fossa were analyzed. Six defects were closed with an anterolateral thigh free flap and one with a radial forearm free flap. In two patients, the flap was secured in an onlay fashion to the defect via a Caldwell-Luc transmaxillary approach. In one patient, the flap was passed transorally, and the pedicle was delivered into the neck via Penrose drain. In two patients, a parapharyngeal technique and in two others, a retropharyngeal was used for nasopharyngeal inset with endoscopic assistance. There were no flap failures, with an average follow-up time of 20.1 (range 3.2 - 47.1) months. One patient required flap repositioning on postoperative day three due to midline shift and intracranial contents compression. The transoral inset flap necessitated flap repositioning on postoperative day 13 to improve the nasopharyngeal airway.

Conclusion: Free flap reconstruction of the central skull base is challenging, but transmaxillary, transoral, parapharyngeal, and retropharyngeal approaches can be used with endoscopic assistance to ensure secure inset flap and avoid airway obstruction.

Recommended Citation

Sagheer, S. Hamad; Swendseid, Brian; Evans, James; Rabinowitz, Mindy; Nyquist, Gurston; Rosen, Marc R.; Toskala, Elina; Heffelfinger, Ryan; Luginbuhl, Adam J.; and Curry, Joseph M., "Free Tissue Transfer for Central Skull Base Defect Reconstruction: Case Series and Surgical Technique" (2021). Department of Otolaryngology - Head and Neck Surgery Faculty Papers. Paper 53.
https://jdc.jefferson.edu/otofp/53

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Language

English