TY - JOUR
T1 - Reconstruction of lateral skull base defects
T2 - A comparison of the submental flap to free and regional flaps
AU - Howard, Brittany E.
AU - Nagel, Thomas H.
AU - Barrs, David M.
AU - Donald, Carrlene B.
AU - Hayden, Richard E.
N1 - Publisher Copyright:
© Official journal of the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Objectives:To compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions between reconstructive approaches to lateral skull base defects. Study Design Case series with chart review. Setting Tertiary academic referral center. Subjects Patients (n = 31) undergoing reconstruction of composite lateral skull base defects from 2002 to 2014. Methods Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes. Results Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions, including squamous cell carcinoma (n = 25), basal cell carcinoma (n = 2), and other carcinoma (n = 4). Defects were reconstructed with submental flaps (n = 16), pedicled latissimus dorsi flaps (n = 6), and free anterolateral thigh flaps (n = 9). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time of surgical resection was similar, time saving was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean, 544 vs 683 min; P =.00817) and duration of hospitalization (4.9 vs 9.8 days; P =.02067). Submental flaps were significantly less likely to require revision debulking procedures (mean = 0.6) compared with latissimus dorsi flaps (mean, 1.3; P <.00001) and free flaps (mean, 1.6; P <.00001). There was 100% flap survival. Conclusion The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions.
AB - Objectives:To compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions between reconstructive approaches to lateral skull base defects. Study Design Case series with chart review. Setting Tertiary academic referral center. Subjects Patients (n = 31) undergoing reconstruction of composite lateral skull base defects from 2002 to 2014. Methods Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes. Results Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions, including squamous cell carcinoma (n = 25), basal cell carcinoma (n = 2), and other carcinoma (n = 4). Defects were reconstructed with submental flaps (n = 16), pedicled latissimus dorsi flaps (n = 6), and free anterolateral thigh flaps (n = 9). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time of surgical resection was similar, time saving was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean, 544 vs 683 min; P =.00817) and duration of hospitalization (4.9 vs 9.8 days; P =.02067). Submental flaps were significantly less likely to require revision debulking procedures (mean = 0.6) compared with latissimus dorsi flaps (mean, 1.3; P <.00001) and free flaps (mean, 1.6; P <.00001). There was 100% flap survival. Conclusion The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions.
KW - CSF leak
KW - anterolateral thigh flap
KW - free flap
KW - island flap
KW - lateral skull base
KW - lateral temporal bone resection
KW - latissimus dorsi
KW - operative time
KW - reconstruction
KW - regional flap
KW - submental flap
KW - subtotal temporal bone
KW - temporal bone
KW - total auriculectomy
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U2 - 10.1177/0194599816634296
DO - 10.1177/0194599816634296
M3 - Article
C2 - 26980913
AN - SCOPUS:84973459538
SN - 0194-5998
VL - 154
SP - 1014
EP - 1018
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 6
ER -