Six-year retrospective study of reconstructive options for defects of the skull base after resection of tumour

• Published in: British journal of oral & maxillofacial surgery 2013-12, Vol.51 (8), p.719-724
• Main Authors: Mohammed-Ali, R.I, Robbins, Amy E, Hussain, O, Fitzgerald, Aidan, Carroll, Thomas, Smith, A.T, Yousefpour, A
• Format: Article
• Language: English
• Subjects: Carcinoma, Squamous Cell - surgery; Cerebrospinal Fluid Leak - etiology; Dentistry; Dura Mater - surgery; Follow-Up Studies; Free Tissue Flaps - transplantation; Head and Neck Neoplasms - surgery; Head and neck oncology; Humans; Microsurgery - methods; Muscle, Skeletal - transplantation; Neoadjuvant Therapy; Postoperative Complications; Radiosurgery; Radiotherapy, Adjuvant; Reconstructive Surgical Procedures - methods; Retrospective Studies; Skull Base - surgery; Skull base reconstruction; Skull base tumours; Surgery; Surgical Flaps - transplantation; Surgical Wound Infection - etiology; Survival Rate; Treatment Outcome
• ISSN: 0266-4356; 1532-1940
• DOI: 10.1016/j.bjoms.2013.06.007

Abstract The successful management of tumours that involve the skull base depends on resection and reconstruction of the defect. The challenge is to create a protective vascularised seal between the intracranial contents and the adjacent paranasal sinuses, nasopharynx, and oral cavity. Failure to create a protective barrier for the intracranial contents can result in cerebrospinal fistulas, potentially fatal infections, and radiotherapy being delayed. Local or regional flaps may be adequate for small defects, but larger ones require microsurgical free tissue transfer. As a part of the skull base surgical team, we present our experience in the reconstruction of defects after resection of tumours. A total of 41 patients had operations over a 6-year period from January 2004 to January 2010, and 26 free tissue transfer flaps and 20 local or regional flaps (46 flaps) were used for reconstruction. Ninety-two percent of the free flaps were successful. We also report details on disease, complications, and survival at 3, 6, and 12 months. Survival depended not only on the type of disease, coexisting conditions, and adequate resection of tumour, but equally on the reconstruction of the defect.