Craniofacial Reconstruction Following Oncologic Resection

Osseointegrated Implants and Prosthetic Reconstruction Following Skull Base Surgery

Rehabilitation following ablative skull base surgery remains a challenging task, given the complexity of the anatomical region, despite the recent advances in reconstructive surgery. Remnant defects following resection of 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 even free tissue transfer. However, not all patients are appropriate surgical candidates and therefore may instead benefit from nonsurgical options for functional and aesthetic restoration. Osseointegrated implants and biocompatible prostheses provide a viable alternative for such a patient population. The purpose of this review serves to highlight current options for prosthetic rehabilitation of skull base defects and describe their indications, advantages, and disadvantages.

Outcomes for olfactory neuroblastoma treated with induction chemotherapy

BACKGROUND

Oncologic outcomes for induction chemotherapy and its role in patients with advanced olfactory neuroblastoma (ONB) remain unclear.

METHODS

A retrospective review of 15 consecutive patients with extensive local invasion and/or nodal disease treated with induction chemotherapy with curative intent followed by definitive local therapy.

RESULTS

The majority of patients were treated with cisplatin and etoposide. The response to chemotherapy was 68% (10/15). Response was 78% (7/9) in the high Hyams high-grade group and 50% (3/6) in the Hyams low-grade group. Seven patients had complete response (CR) and 3 patients were able to avoid orbital exenteration. The 5-year disease-free survival (DFS) and overall survival (OS) were 71% and 78%, respectively, with a trend toward improved survival in patients with CR.

CONCLUSION

ONB is a chemosensitive tumor and induction chemotherapy is an acceptable strategy for aggressive and locoregional advanced disease. Hyams grade may predict chemosensitivity and CR may be associated with improved survival.

Modified technique to improve fabrication and outcome of definitive orbital prosthesis

Facial prostheses are generally fabricated from silicones, which provide life-like appearance and flexibility. The longevity of silicone, however, is limited because of its tendency to support fungal growth, absorb oils and grease, and edge-tearing susceptibility. Polyurethane (PU) liners have been used on the tissue-bearing surface of such prosthesis to improve tear resistance and fungal resistance. Technique sensitivity, discoloration and metamerism are significant limitations of urethane lining. Further, this liner is incorporated during processing of definitive prosthesis, which precludes try-in of tissue surface of prosthesis. This article describes an alternative lining material for fitting surface of definitive orbital prostheses, which could overcome limitations associated with all silicone or PU lined silicone prostheses.

Porcine small intestine submucosal grafts for post-tumor resection orbital reconstruction

OBJECTIVES/HYPOTHESIS

Removal of the medial orbital wall for sinonasal tumor involvement is required to obtain complete oncologic resection. However, orbital fat herniation can produce significant morbidity, including enophthalmos and diplopia. The purpose of the current study was to evaluate outcomes following use of porcine small intestine submucosa (SIS) grafts for orbital reconstruction following extirpation of sinonasal malignancies.

STUDY DESIGN

Case series in a tertiary hospital setting.

METHODS

Review of prospectively collected data regarding orbital reconstruction using SIS was performed. Demographics, tumor histology, size of orbital defect, adjuvant treatment, clinical status, and complications were recorded.

RESULTS

Seventeen patients (average age, 58 years; range, 27-82 years) had SIS grafting of the medial orbital wall over a 5-year period at our tertiary academic institution. The average orbital wall defect size was 4.6 cm(2) (range, 1 cm(2)-24 cm(2)). Tumor histopathology included esthesioneuroblastoma (n = 5), squamous cell carcinoma (n = 4), adenocarcinoma (n = 2), sinonasal undifferentiated carcinoma (n = 2), melanoma (n = 3), and neuroendocrine carcinoma (n = 1). Surgical goals were curative intent in all patients. Ten patients had postoperative radiation therapy, whereas five individuals had surgical extirpation following neoadjuvant chemotherapy and radiation. All patients had complete locoregional control at last clinical follow-up (average, 16 months; range, 2-54 months), although three patients developed distant metastases. The only orbital complications noted were enophthalmos (n = 1), periorbital cellulitis (n = 1), and orbital wall crusting (n = 1).

CONCLUSIONS

SIS reconstruction of orbital wall defects was effective in the current series of patients, with only one patient developing noticeable enophthalmos and a low incidence of surgical complications.

LEVEL OF EVIDENCE

4.