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Ordoyne LM, Alvarez I, Borne G, Fabian I, Adilbay D, Kandula RA, Asarkar AA, Nathan CAO, Olinde L, Pang J. Risk Factors for Complications in Patients Undergoing Temporal Bone Resection and Neck Dissection: Insights From a National Database. Ann Otol Rhinol Laryngol 2024; 133:686-694. [PMID: 38712888 DOI: 10.1177/00034894241252541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Temporal bone resection (TBR) with or without neck dissection (ND) is performed for otologic malignancies with occult or clinical cervical lymph node metastases. To date, characterization of post-operative complications in single institution case series may be non-representative of real-world outcomes. Here, we used data from the National Inpatient Sample (NIS) to comprehensively assess the complications encountered, their frequencies, and to identify underlying risk factors to improve future outcomes. METHODS The population was patients undergoing TBR and ND derived from the NIS between the years of 2017 and 2019. We utilized ICD-10 diagnosis codes to identify patients with post-operative complications, those discharged to non-home facilities (DNHF), and those with increased length of stay (LOS). Multivariable regression was performed to identify significant variables related to the above outcomes. RESULTS Ninety of 277 patients that underwent LTBR with ND had postoperative complications. Wound complications were the most frequent complication, occurring in 11 (4%) of patients, followed by CSF leak (n = 6; 2.2%), with acute respiratory failure being the most common medical complication (n = 4; 1.4%). Sixteen percent (45/277) were discharged to a facility besides home. Dementia (OR = 7.96; CI95 3.62-17.48), anemia (OR = 2.39; CI95 1.15-4.99), congestive heart failure (OR = 5.31; CI95 1.82-15.45), COPD (OR = 3.70; CI95 1.35-10.16), and history of prior stroke (OR = 8.50; CI95 1.55-46.68) increased the odds of DNHF. When evaluating LOS (median = 5 days, IQR = 1, 9), anemia (OR = 5.49; CI95 2.86-10.52), and Medicaid insurance (OR = 3.07; CI95 1.06-10.52) were found to increase the LOS. CONCLUSIONS The vast majority of patients undergoing LTBR with ND have no complications and are discharged within a week. Liver disease is a risk factor for medical complications and increased charges. Patients with dementia or a prior stroke are at risk for DNHF, and those with prior anemia are at risk for a wound complication. LAY SUMMARY This study identified factors related to worse post-operative outcomes in patients undergoing temporal bone resection and neck dissection. Although safe for most patients, an existing diagnosis of liver disease, stroke, dementia, and anemia specifically are at risk for developing negative outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Liam M Ordoyne
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Ivan Alvarez
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Grant Borne
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Isabella Fabian
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Dauren Adilbay
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Rema A Kandula
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Ameya A Asarkar
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
| | - Lindsay Olinde
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
| | - John Pang
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
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Shikano Y, Tashima H, Kuroda K, Otani N, Seike S, Kubo T. Fat-augmented Temporal Fascia Flap for Defect Coverage following External Auditory Canal Cancer Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5839. [PMID: 38798943 PMCID: PMC11124592 DOI: 10.1097/gox.0000000000005839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 05/29/2024]
Abstract
Malignant tumors of the external auditory canal are rare and require surgical interventions such as lateral temporal bone resection (LTBR) for localized cases. This study introduces a novel approach, the lipofilling fascia flap technique, for external auditory canal reconstruction following LTBR or modified LTBR. The technique involves augmenting the temporal fascia flap with autologous fat grafting, aiming to enhance volume and improve outcomes. Two cases are presented, demonstrating successful reconstruction with minimal complications.
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Affiliation(s)
- Yusuke Shikano
- From the Department of Plastic and Reconstructive Surgery, Osaka University Hospital, Osaka, Japan
| | - Hiroki Tashima
- Tashima Dermatology and Plastic Surgery Clinic, Osaka, Japan
| | - Kazuya Kuroda
- From the Department of Plastic and Reconstructive Surgery, Osaka University Hospital, Osaka, Japan
| | - Naoya Otani
- From the Department of Plastic and Reconstructive Surgery, Osaka University Hospital, Osaka, Japan
| | - Shien Seike
- From the Department of Plastic and Reconstructive Surgery, Osaka University Hospital, Osaka, Japan
| | - Tateki Kubo
- From the Department of Plastic and Reconstructive Surgery, Osaka University Hospital, Osaka, Japan
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Ucisik FE, Huell D, Choi J, Gidley PW, DeMonte F, Hanna EY, Learned KO. Post-Treatment Imaging Evaluation of the Skull Base. Semin Roentgenol 2023; 58:217-236. [PMID: 37507165 DOI: 10.1053/j.ro.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/09/2023] [Accepted: 03/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- F Eymen Ucisik
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Derek Huell
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeanie Choi
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Kim O Learned
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Kejner AE, Lee BJ, Pipkorn P. Lateral Skull Base and Auricular Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00073-7. [PMID: 37258407 DOI: 10.1016/j.otc.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Reconstruction of the lateral temporal bone with adequate functional and cosmetic outcomes depends on a multidisciplinary approach including the head and neck surgeon, reconstructive surgeon, neurotologist, and anaplastologist. Approaching the defect includes consideration of the location, tissue type, function, and patient/tumor characteristics. Anatomic limitations due to prior therapy also play an important role in reconstructive choices. Here, we review contemporary literature regarding the reconstruction of this complex region.
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Affiliation(s)
- Alexandra E Kejner
- Division of Head & Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue MSC 550, Charleston, SC 29436, USA.
| | - Byung Joo Lee
- Division of Maxillofacial Prosthodontics, MUSC 135 Rutledge Avenue MSC 550, Charleston, SC 29436, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO 63110, USA
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Bashorun OH, Johnson RM, Johnson EA. Flap Debulking and Secondary Revisions in Head and Neck Reconstruction: A Systematic Review with Clinical Applications. Semin Plast Surg 2023; 37:73-82. [PMID: 36776802 PMCID: PMC9911221 DOI: 10.1055/s-0042-1760444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Flap debulking and secondary revisions are an integral factor in providing optimum outcomes to reconstructive patients. This review article summarizes systematically the available literature on flap debulking in head and neck reconstruction. The clinical applications of debulking techniques are discussed, including fractional direct excision, liposuction, and single-stage excision or planning with skin grafting. New technologies are also discussed.
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Affiliation(s)
- Olatunde H. Bashorun
- Department of Plastic and Reconstructive Surgery, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - R. Michael Johnson
- Department of Plastic and Reconstructive Surgery, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Elise A. Johnson
- Department of Plastic and Reconstructive Surgery, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Ross University Medical School, Bridgetown, Barbados
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The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect. Microsurgery 2022; 43:309-315. [PMID: 36541252 DOI: 10.1002/micr.30997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND A radical parotidectomy with facial nerve sacrifice results in facial nerve paralysis as well as a volume and often cutaneous defect. Prior experience with nerve grafting and static suspension has yielded suboptimal results. The present report aims to examine the feasibility and outcomes of a combined free gracilis and profunda artery perforator (PAP) flap from a single donor site can reconstruct these extensive defects and potentially restore dynamic facial reanimation even in the setting of adjuvant radiation. PATIENTS AND METHODS A retrospective review of 10 patients (6 males and 4 females) was performed from 2016 to 2020 that underwent a combined PAP-gracilis reconstruction of a radical parotidectomy defect. All patients (mean age: 71.3 years; range: 52-83 years) received adjuvant radiation. A chimeric PAP-gracilis flap requiring a single microvascular anastomosis was performed in three patients while the remaining patients underwent a double free flap reconstruction. RESULTS The gracilis flap was innervated using the facial nerve stump, spinal accessory and massecteric nerve in three patients each. One patient's gracilis was innervated using the hypoglossal nerve. Three patients also underwent nerve grafting of the facial nerve. One patient was taken back to the operating room for a hematoma in the recipient site and there were not flap losses of either the PAP or gracilis flap. Two patients had delayed wound healing of the donor site that healed with conservative management. Average follow-up was 11.1 months (range: 8.1-19.5 months). Six patients were able to achieve dynamic animation while the others obtained a static reconstruction and did not have issues with drooling, eating, or speaking. CONCLUSIONS Immediate functional muscle transfer can potentially restore dynamic facial reanimation even following radiation. Combining reconstruction using a PAP-gracilis flap addresses the soft tissue deficit and facial paralysis using a single donor site in a single operation.
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Katre MI, Chintale SG, Deshmukh SD, Keche PN, Dhanajkar PS. Study of Clinicopathological Presentation and Management of Malignant Tumours of the Ear and Temporal Bone at Tertiary Care Cancer Hospital. Indian J Otolaryngol Head Neck Surg 2022; 74:3662-3670. [PMID: 36742586 PMCID: PMC9895243 DOI: 10.1007/s12070-020-02346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Tumors of the ear can be benign or malignant. They can occur on the external ear or in the ear canal, the middle ear, and inner ear. Tumors in different areas of the ear behave differently. They are rare which causes several problems in diagnosis and appropriate treatment. The purpose of this study was to analyze retrospectively the patients with malignant neoplasm of the ear. The main objectives of this study were to study the clinicopathological presentation of ear and temporal bone malignancy and to study the management of different types of malignancy of ear and temporal bone. This study is conducted at our tertiary care cancer hospital from Feb 2015 to Jan 2020. This study includes 15 patients treated for malignancy of the external and middle ear. The entire patient was thoroughly examined for malignancy. Details ENT examination was done. History of smoking and tobacco chewing asked. The patient factors considered in this study were age, sex, diagnosis, treatment (surgery, radiotherapy, and chemotherapy), complications, follow-up, and recurrence. This study includes [n = 15] patients. Due to a variety of malignant lesions of the ear and temporal bone they were classified into two groups, Superficial location lesions [n = 5] 3 of disease limited to pinna and 2 cases of primary of parotid origin involving pinna. Deep location involving external auditory meatus and middle ear [n = 12]. In this study of [n = 15] cases lowest age was 18 years. male and highest age was 75 years. male and most common age group was 56-65 years in which [n = 7] patients present. In this study we studied [n = 11] male patients and [n = 4] female patients. The most common symptom present was ear discharge [n = 8], the next common symptom was hard of hearing [n = 7]. A less common symptom was facial weakness [n = 3]. In sign, mastoid tenderness was commonest in [n = 5], and less common was facial palsy in [n = 3]. In our study of [n = 15] patients we did lateral temporal bone resection in [n = 5] patients, wide local excision of lesion in [n = 4] patients, lateral temporal bone resection with postero-lateral neck dissection with PMMC flap done in [n = 2] patients. In our study of [n = 15] cases of ear malignancy most common histopathology is squamous cell carcinoma [n = 12] cases, least were basal cell carcinoma [n = 1], melanoma [n = 1], and Rhabdomyosarcoma [n = 1]. Malignant tumors of the ear and temporal bone are rare. Neoplasm's of the external and middle ear constitutes a group of various histopathological and clinical tumors that differ in diagnostic difficulties, treatment, and prognosis. Surgery is the mainstay of treatment followed by reconstruction. Radiotherapy and chemotherapy play an adjuvant role in post-operative management in the high-risk category. Prognosis is worst as the tumor stage advances. And most of the cases diagnosis was often made in the advanced stage especially for middle ear tumors that diminished the possibility of effective treatment.
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Affiliation(s)
- Mahendra I. Katre
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
| | - Sambhaji G. Chintale
- Department of Otorhinolaryngology, JIIUS IIMSR, Warudi TQ Badnapur Dist., Jalna, 431202 India
- Director Cosmoent Super-Speciality Hospital and Research Center Aurangabad, Kamgar chauk cidco n3, Aurangabad, 431005 India
| | - Sunil D. Deshmukh
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
| | - Prashant N. Keche
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
| | - Pramod S. Dhanajkar
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
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Mays AC, Yarlagadda B, Achim V, Jackson R, Pipkorn P, Huang AT, Rajasekaran K, Sridharan S, Rosko AJ, Orosco RK, Coughlin AM, Wax MK, Shnayder Y, Spanos WC, Farwell DG, McDaniel LS, Hanasono MM. Examining the relationship of immunotherapy and wound complications following flap reconstruction in patients with head and neck cancer. Head Neck 2021; 43:1509-1520. [PMID: 33417293 DOI: 10.1002/hed.26601] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 12/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunotherapy agents are used to treat advanced head and neck lesions. We aim to elucidate relationship between immunotherapy and surgical wound complications. METHODS Retrospective multi-institutional case series evaluating patients undergoing ablative and flap reconstructive surgery and immunotherapy treatment. MAIN OUTCOME wound complications. RESULTS Eight-two (62%) patients received preoperative therapy, 89 (67%) postoperative, and 33 (25%) in both settings. Forty-one (31%) patients had recipient site complications, 12 (9%) had donor site. Nineteen (14%) had major recipient site complications, 22 (17%) had minor. There was no statistically significant difference in complications based on patient or tumor-specific variables. Preoperative therapy alone demonstrated increased major complications (odds ratio [OR] 3.7, p = 0.04), and trend to more donor site complications (OR 7.4, p = 0.06), however treatment in both preoperative and postoperative therapy was not. CONCLUSIONS Preoperative immunotherapy may be associated with increased wound complications. Controlled studies are necessary to delineate this association and potential risks of therapy.
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Affiliation(s)
- Ashley C Mays
- Department of Otolaryngology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Bharat Yarlagadda
- Department of Otolaryngology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Virginie Achim
- Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ryan Jackson
- Department of Otolaryngology, Washington University - St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University - St Louis, St Louis, Missouri, USA
| | - Andrew T Huang
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Karthik Rajasekaran
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shaum Sridharan
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew J Rosko
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan K Orosco
- Department of Otolaryngology, University of California San Diego, San Diego, California, USA
| | - Andrew M Coughlin
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha, Nebraska, USA
| | - Mark K Wax
- Department of Otolaryngology, Oregon Health Sciences University, Portland, Oregon, USA
| | | | - William C Spanos
- Department of Otolaryngology, Sanford Health, Sioux Falls, South Dakota, USA
| | - Donald Gregory Farwell
- Department of Otolaryngology, University of California Davis, Sacramento, California, USA
| | - Lee S McDaniel
- Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
| | - Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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External auditory canal carcinoma: clinical characteristics and long-term treatment outcomes. Eur Arch Otorhinolaryngol 2020; 277:2709-2720. [PMID: 32367152 DOI: 10.1007/s00405-020-06019-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/26/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Evidence-based treatment recommendations for external auditory canal (EAC) carcinoma are lacking in available literature. This study aims to evaluate the clinical characteristics and long-term outcomes of EAC carcinoma in a tertiary referral centre in a period of 15 years and identify independent prognostic factors. METHODS Retrospective observational study enrolling all patients with primary EAC carcinoma who underwent primary surgical treatment at the Portuguese Institute of Oncology (Lisbon) between 2004 and 2018. Epidemiological, clinical, histopathological and surgical data were retrieved from clinical records and analysed. RESULTS Twenty-seven patients were identified, with a median age of 77 years (range 29-92 years) and a slight female predominance (59.3%). Squamous cell carcinoma (55.6%) was the most common histological type, followed by basal cell carcinoma (40.7%) and ceruminous adenocarcinoma (3.7%). Pittsburgh tumour staging was distributed as early stage in 51.9% (I: 40.7%; II: 11.1%) and advanced stage in 48.1% (III: 29.6%; IV: 18.5%). Median follow-up period was 21 months (interquartile-range: 47). Four patients (14.8%) showed recurrence; recurrence rate was significantly higher in individuals aged < 60 years (p = 0.025) and with lymphovascular invasion (p = 0.049). Median overall survival was 88 months and estimated 2-year and 5-year overall survival rates were both 66%. Survival rates were higher in early stage patients (p = 0.021) and in those without facial palsy (p = 0.032). CONCLUSION Based on the available evidence in this review, individuals aged < 60, facial nerve impairment, advanced stage lesions, presence of lymphovascular invasion and squamous cell carcinoma histology are all associated with poor outcome and may be considered when discussing optimal treatment strategies in patients with EAC carcinoma.
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Zwierz A, Masna K, Burduk P. The Use of Giant Bilobed Flaps for Tissue Defect Reconstruction After Temporal Bone and Ear Resection. EAR, NOSE & THROAT JOURNAL 2020; 100:651-655. [PMID: 32302227 DOI: 10.1177/0145561320918986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this article was to feature the use of giant bilobed flaps in surgical reconstruction after total or subtotal petrosectomy in oncology cases. The Esser technique was renewed and adopted for coverage huge skin loss. The authors reported 4 cases illustrated pre- and postoperative photography and intraoperative planning and schema. Good coverage and healing with no need for use of free tissue transfer or skin expanders or skin grafts was obtained. In authors' opinion, the cosmetic effect was acceptable. Surgical times of operation were significantly shorter.
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Affiliation(s)
- Aleksander Zwierz
- Faculty of Health Sciences, Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krystyna Masna
- Faculty of Health Sciences, Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Paweł Burduk
- Faculty of Health Sciences, Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
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Mehta GU, Muelleman TJ, Brackmann DE, Gidley PW. Temporal bone resection for lateral skull-base malignancies. J Neurooncol 2020; 150:437-444. [PMID: 32108295 DOI: 10.1007/s11060-020-03445-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Malignancies involving the temporal bone are increasingly common and require specialized multi-disciplinary care. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. In this review we discuss general principles for temporal bone resection, as well as alternative and complementary surgical approaches that should be considered in the management of patients with temporal bone cancer. METHODS A comprehensive review on literature pertaining to temporal bone resection was performed. RESULTS The primary surgical strategy for malignancies of the temporal bone is temporal bone resection. This may be limited to the ear canal and tympanic membrane (lateral temporal bone resection) or may include the otic capsule and its contents (subtotal temporal bone resection), and/or the petrous apex (total temporal bone resection). Management of adjacent neurovascular structures including the facial nerve, the carotid artery, and the jugular bulb/sigmoid sinus should be considered during surgical planning. Finally, adjunctive procedures such as parotidectomy and neck dissection may be required based on tumor stage. CONCLUSIONS Temporal bone resection is an important technique in the treatment of lateral skull-base malignancies. This strategy should be incorporated into a multi-disciplinary approach to cancer.
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Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Ste 111, Los Angeles, CA, USA.
| | | | | | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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12
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Hanasono MM. Reconstruction after open surgery for skull-base malignancies. J Neurooncol 2020; 150:469-475. [DOI: 10.1007/s11060-019-03370-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/11/2019] [Indexed: 01/20/2023]
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Lindquist NR, Vinh DB, Appelbaum EN, Vrabec JT, Huang AT. Microvascular free tissue transfer and cochlear implants: A case series and literature review. Laryngoscope 2019; 130:1552-1557. [PMID: 31654455 DOI: 10.1002/lary.28300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/17/2019] [Accepted: 08/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The use of microvascular free tissue transfer (MVFTT) for defects of the scalp and lateral temporal bone in patients with cochlear implants (CI) is uncommon. Herein, we report our experience with the utility, indications, and outcomes for MVFTT in patients with cochlear implants. METHODS A retrospective review of patients at our institution from September 2016 to December 2017 identified subjects with coexistent cochlear implant and ipsilateral MVFTT of the lateral temporal bone or scalp. Information including demographics, indication for MVFTT, timing of CI and MVFTT, donor site, and previous radiation to the head and neck was collected. To assess the current literature on MVFTT in CI patients, a MEDLINE search was performed using key search terms. RESULTS Two patients with cochlear implants and MVFTT of the ipsilateral temporal bone or scalp were identified. One patient underwent MVFTT for advanced device extrusion with stable audiometric parameters rather than locoregional reconstruction or device explantation. The second patient had primary cochlear implantation at oncologic lateral temporal bone resection (LTBR) and MVFTT for locally advanced squamous cell carcinoma and concurrent profound sensorineural hearing loss (SNHL). A literature review identifies MVFTT as an option for advanced device extrusion, treatment of osteoradionecrosis, and reconstruction after primary oncologic surgery. CONCLUSION MVFTT is an important reconstructive tool for patients with functional, exposed cochlear implants. Cochlear implantation for severe to profound SNHL should be considered at the time of primary oncologic surgery and MVFTT of the lateral temporal bone or scalp. LEVEL OF EVIDENCE IV Laryngoscope, 130:1552-1557, 2020.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Daniel B Vinh
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Eric N Appelbaum
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Jeffrey T Vrabec
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Andrew T Huang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Trojanowski P, Szymański M, Trojanowska A, Andrzejczak A, Szczepanek D, Klatka J. Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection. Eur Arch Otorhinolaryngol 2019; 276:3487-3494. [PMID: 31515663 PMCID: PMC6858904 DOI: 10.1007/s00405-019-05627-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/30/2019] [Indexed: 01/13/2023]
Abstract
Purpose Evaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution. Methods An analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap. Results Tumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications. Conclusions The ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.
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Affiliation(s)
- Piotr Trojanowski
- Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland.
| | - Marcin Szymański
- Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland
| | | | - Adrian Andrzejczak
- Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Janusz Klatka
- Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland
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Abstract
The aim of the study is to discuss the current management options for intra- and extra-cranial communication giant cell tumor of the lateral skull base and perform a review of the literature. A total of 6 patients with giant cell tumor of the lateral skull base were retrospectively enrolled in the study. The principal complaints, imaging manifestations, surgical resection and reconstruction of intra- and extra-cranial communication defects for the diseases were discussed. There were 2 males and 4 females. The most of principal complaints were discomfort or pain in the temporomandibular joint in 5 cases (83.3%). Imaging examination showed invasion of the temporal bone alone in 3 cases (50.0%) and both temporal bone and sphenoid bone involvement in 3 cases (50.0%). C-shaped preauricular infratemporal fossa approach was used for tumour removal and gross total resection was done in all 6 cases. The pedicled temporal muscle fascial flap was used to reconstruct the intra- and extra-cranial communication defect of the lateral skull base. The conclusion is that giant cell tumor is a benign tumor but is also locally aggressive. Gross total resection is the most commonly recommended treatment choice for giant cell tumor of the skull and can achieve good treatment outcomes. The temporalis muscle flap is a good alternative choice for reconstruction of the defect.
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16
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Reconstruction of Temporal Bone Defect Using a Vertically-Oriented Free Muscle-Sparing Rectus Abdominis Musculocutaneous Flap. J Craniofac Surg 2018; 29:1884-1886. [DOI: 10.1097/scs.0000000000004794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Outcomes of reconstruction after temporal bone resection for malignancy. J Craniomaxillofac Surg 2018; 46:1856-1861. [DOI: 10.1016/j.jcms.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/19/2022] Open
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18
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Arnaoutakis D, Kadakia S, Abraham M, Lee T, Ducic Y. Locoregional and Microvascular Free Tissue Reconstruction of the Lateral Skull Base. Semin Plast Surg 2017; 31:197-202. [PMID: 29075158 DOI: 10.1055/s-0037-1606556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The goals of reconstruction following any oncologic extirpation are preservation of function, restoration of cosmesis, and avoidance of morbidity. Anatomically, the lateral skull base is complex and conceptually intricate due to its three-dimensional morphology. The temporal bone articulates with five other cranial bones and forms many sutures and foramina through which pass critical neural and vascular structures. Remnant defects following resection of lateral skull base tumors are often not amenable to primary closure. As such, numerous techniques have been described for reconstruction including local rotational muscle flaps, pedicled flaps with skin paddle, or free tissue transfer. In this review, the advantages and disadvantages of each reconstructive method will be discussed as well as their potential complications.
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Affiliation(s)
| | - Sameep Kadakia
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Manoj Abraham
- Department of Otolaryngology-Head and Neck Surgery, New York Medical College, Valhalla, New York
| | - Thomas Lee
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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19
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Reconstruction of parotidectomy and lateral skull base defects. Curr Opin Otolaryngol Head Neck Surg 2017; 25:431-438. [DOI: 10.1097/moo.0000000000000391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Wierzbicka M, Niemczyk K, Bruzgielewicz A, Durko M, Klatka J, Kopeć T, Osuch-Wójcikiewicz E, Pietruszewska W, Szymański M, Szyfter W. Multicenter experiences in temporal bone cancer surgery based on 89 cases. PLoS One 2017; 12:e0169399. [PMID: 28225795 PMCID: PMC5321293 DOI: 10.1371/journal.pone.0169399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/13/2016] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To present outcomes of extensive surgery: lateral, subtotal, total petrosectomies in patients with temporal bone invasion resulting from specific primary cancers. STUDY DESIGN Retrospective case review. SETTING Four tertiary referral centers. MATERIAL 89 patients with cancer of the temporal bone treated between January 2006 and December 2010. INTERVENTION Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy. MAIN OUTCOME MEASURE Disease-specific survival, overall survival. RESULTS In 27.0% of the patients, relapse was reported, with an average of 6.3 months after surgery; 31 patients (34.8%) died during the follow-up. The average mortality was 22.1 months. Fifty-four patients (58.7%) stayed alive during the time of observation. The average survival time was 42.0 months. The median time of survival with relapse was 12 months (range: 1-51 months). The three-year disease-free rate was 38.0% and the overall survival rate was 58.7%. CONCLUSIONS Petrosectomy is an effective treatment for malignant temporal bone invasion. The probability of a good outcome was statistically decreased with a high T grade, positive margins, and salvage surgery. Younger age is connected with better prognosis. One of the major tasks remains to improve detection and to shorten the time to diagnosis, keeping in mind that symptoms are insidious and in younger people, the time before diagnosis was longer.
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Affiliation(s)
| | | | | | - Marcin Durko
- ENT Department, Medical University, Łódź, Poland
| | | | - Tomasz Kopeć
- ENT Department, Medical University, Poznań, Poland
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21
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Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition.
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22
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Wierzbicka M, Kopeć T, Szyfter W, Buczkowska A, Borucki Ł. Efficacy of petrosectomy in malignant invasion of the temporal bone. Br J Oral Maxillofac Surg 2016; 54:778-83. [DOI: 10.1016/j.bjoms.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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23
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Cristóbal L, Linder S, Lopez B, Mani M, Rodríguez-Lorenzo A. Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes. Microsurgery 2016; 37:479-486. [PMID: 27501201 DOI: 10.1002/micr.30086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area. METHODS Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function. RESULTS There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one. CONCLUSION Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.
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Affiliation(s)
- Lara Cristóbal
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Sora Linder
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Beatriz Lopez
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Maria Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Andres Rodríguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
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24
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Naunheim M, Seth R, Knott PD. Sternocleidomastoid contour restoration: an added benefit of the anterolateral thigh free flap during facial reconstruction. Am J Otolaryngol 2016; 37:139-43. [PMID: 26954870 DOI: 10.1016/j.amjoto.2015.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To demonstrate the potential of the anterolateral thigh free flap for neck contour restoration. STUDY DESIGN Retrospective chart review at a tertiary care medical center of patients who underwent radical parotidectomy with sternocleidomastoid sacrifice, with or without temporal bone resection, and reconstruction of both facial and cervical contour with the anterolateral thigh free flap between November 2011 and March 2015. Seven patients were included and demographics, flap viability, pathology and tumor staging, surgical intervention, adjunctive reanimation procedures, ischemia time, and pre-operative and post-operative photos were recorded and analyzed. RESULTS There were no flap failures and the mean ischemia time was 82 minutes. There were 2 recipient site complications. Post-operative neck symmetry was improved for all 7 patients. CONCLUSIONS The adipofascial anterolateral thigh flap is useful for improving the aesthetic contour of the neck among patients undergoing sternocleidomastoid muscle resection/disinsertion following total parotidectomy with/without temporal bone resection. Contour restoration may be performed with minimal added morbidity and with relatively little additional operative time. This technique may be adapted for other complex facial and neck defects caused by ablative surgery. LEVEL OF EVIDENCE 4.
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25
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Patel NS, Modest MC, Brobst TD, Carlson ML, Price DL, Moore EJ, Janus JR. Surgical management of lateral skull base defects. Laryngoscope 2015; 126:1911-7. [DOI: 10.1002/lary.25717] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/01/2015] [Accepted: 09/10/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Neil S. Patel
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Mara C. Modest
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Tyler D. Brobst
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Matthew L. Carlson
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel L. Price
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Jeffrey R. Janus
- Department of Otorhinolaryngology; Mayo Clinic; Rochester Minnesota U.S.A
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26
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Garg RK, Poore SO, Wieland AM, Mcculloch TM, Hartig GK. Elective free flap revision in the head and neck cancer patient: Indications and outcomes. Microsurgery 2015; 35:591-5. [DOI: 10.1002/micr.22506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Ravi K. Garg
- Division of Plastic and Reconstructive Surgery; Department of Surgery; University of Wisconsin; Madison WI
| | - Samuel O. Poore
- Division of Plastic and Reconstructive Surgery; Department of Surgery; University of Wisconsin; Madison WI
| | - Aaron M. Wieland
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Wisconsin; Madison WI
| | - Timothy M. Mcculloch
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Wisconsin; Madison WI
| | - Gregory K. Hartig
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Wisconsin; Madison WI
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27
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Littlefield PD, Tolisano AM, Sabol JV, Herberg ME, Coppit GL. Total Auricular Rehabilitation: Combined Cosmetic and Functional Lateral Temporal Bone Reconstruction. J Craniofac Surg 2015; 26:1467-70. [PMID: 26114506 DOI: 10.1097/scs.0000000000001770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of the study was to describe 3 cases of total auricular rehabilitation, including the novel use of iliac crest bone grafts to support bone-anchored auricular prostheses. STUDY DESIGN This study is a retrospective case series from a single institution. RESULTS Three cases with large lateral temporal bone and soft tissue defects were successfully treated with total auricular rehabilitation. Rehabilitation included the following: soft tissue coverage with an anterolateral thigh microvascular free flap, iliac crest-free bone graft with staged placement of a bone-anchored auricular prosthesis into the bone graft, and audiologic rehabilitation with a bone-anchored hearing aid (BAHA). All of the cases with grafts and flaps survived and were without significant donor site morbidity. Bone-anchored hearing aid abutment skin overgrowth was seen in 2 cases and was revised under local anesthesia. All of the patients had expected functional recovery on postoperative audiologic testing. Each patient continues to consistently wear his/her auricular prosthesis and BAHA during 3 years of follow-up. CONCLUSIONS Total auricular rehabilitation is a complex task involving reconstruction of extensive soft tissue defects, bony defects, and the hearing apparatus. Acceptable cosmetic and functional outcomes and high patient satisfaction is possible in committed patients.
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Affiliation(s)
- Philip D Littlefield
- *Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI †Department of Otolaryngology ‡Department of Maxillofacial Prosthetics, Walter Reed National Military Medical Center, Bethesda, MD
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28
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Komune N, Komune S, Morishita T, Rhoton AL. Microsurgical anatomy of subtotal temporal bone resection en bloc with the parotid gland and temporomandibular joint. Neurosurgery 2015; 10 Suppl 2:334-56; discussion 356. [PMID: 24561868 DOI: 10.1227/neu.0000000000000324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subtotal temporal bone resection (STBR) has been used for half a century to remove temporal bone malignancies. However, there are few reports on the detailed anatomy involved in the resection. OBJECTIVE To describe the microsurgical anatomy of STBR combined en bloc with the resection of the parotid gland and temporomandibular joint (TMJ). METHODS Cadaveric specimens were dissected in a stepwise manner using 3× to 40× magnification. RESULTS STBR can be combined with the total parotidectomy and the resection of the TMJ if the tumor extends into the parotid gland, TMJ, or facial nerve. In this study, we describe the step-by-step microsurgical anatomy of STBR en bloc with the parotid gland and TMJ. The surgical technique described combines 3 approaches: the high cervical, subtemporal-infratemporal fossa, and retromastoid-paracondylar approaches. Combining these 3 approaches aided in efficiently completing this modified approach. CONCLUSION STBR is a complicated and technically challenging procedure. This study highlights the importance of understanding the surgical anatomy of STBR and will serve as a catalyst for improvement of the surgical technique for temporal bone resection.
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Affiliation(s)
- Noritaka Komune
- *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Otorhinolaryngology Head and Neck Surgery, Kyushu University, Fukuoka, Japan
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29
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Richmon JD, Yarlagadda BB, Wax MK, Patel U, Diaz J, Lin DT. Locoregional and free flap reconstruction of the lateral skull base. Head Neck 2014; 37:1387-91. [DOI: 10.1002/hed.23725] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/11/2014] [Accepted: 04/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jeremy D. Richmon
- Department of Otolaryngology; Johns Hopkins University; Baltimore Maryland
| | - Bharat B. Yarlagadda
- Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Mark K. Wax
- Department of Otolaryngology; Oregon Health and Sciences University; Portland Oregon
| | - Urjeet Patel
- Department of Otolaryngology; Northwestern University; Chicago Illinois
| | - Jason Diaz
- Department of Otolaryngology; Washington University; St. Louis Missouri
| | - Derrick T. Lin
- Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
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30
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Lionello M, Stritoni P, Facciolo M, Staffieri A, Martini A, Mazzoni A, Zanoletti E, Marioni G. Temporal bone carcinoma. Current diagnostic, therapeutic, and prognostic concepts. J Surg Oncol 2014; 110:383-92. [DOI: 10.1002/jso.23660] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/29/2014] [Indexed: 12/25/2022]
Affiliation(s)
- M. Lionello
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - P. Stritoni
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
- Visiting Doctor at Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York, USA
| | - M.C. Facciolo
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - A. Staffieri
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - A. Martini
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - A. Mazzoni
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - E. Zanoletti
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - G. Marioni
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
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