Reconstruction After Temporal Bone Resection

Gal, Thomas J.; Kerschner, Joseph E.; Futran, Neal D.; Bartels, Loren J.; Farrior, Jay B.; Ridley, Marion B.; Klotch, Douglas W.; Endicott, James N.

doi:10.1097/00005537-199804000-00003

Cited by 56 publications

(48 citation statements)

References 6 publications

(3 reference statements)

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“…Regional flaps and vascularized free-tissue transfer afford tremendous versatility and can be used to reconstruct large composite defects but carry several notable drawbacks, including increased donor site morbidity, added surgical time, excessive bulk, and the potential need for extensive undermining. 6,12,28 For these reasons, such options are generally reserved for patients with poor healing capacity, complex or large defects following tumor resection, and in cases where external beam radiation is anticipated.…”

mentioning

confidence: 99%

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Carlson¹,

Copeland

Driscoll

et al. 2013

JNS

116

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Object The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. Methods A retrospective case series including all patients who underwent a middle fossa craniotomy or combined mastoid–middle cranial fossa repair of encephalocele and/or CSFF between 2000 and 2012 was accrued from 2 tertiary academic referral centers. Results Eighty-nine consecutive surgeries (86 patients, 59.3% women) were included. The mean age at time of surgery was 52.3 years, and the left side was affected in 53.9% of cases. The mean delay between symptom onset and diagnosis was 35.4 months, and the most common presenting symptoms were hearing loss (92.1%) and persistent ipsilateral otorrhea (73.0%). Few reported a history of intracranial infection (6.7%) or seizures (2.2%). Thirteen (14.6%) of 89 cases had a history of major head trauma, 23 (25.8%) were associated with chronic ear disease without prior operation, 17 (19.1%) occurred following tympanomastoidectomy, and 1 (1.1%) developed in a patient with a cerebral aqueduct cyst resulting in obstructive hydrocephalus. The remaining 35 cases (39.3%) were considered spontaneous. Among all patients, the mean body mass index (BMI) was 35.3 kg/m2, and 46.4% exhibited empty sella syndrome. Patients with spontaneous lesions were statistically significantly older (p = 0.007) and were more commonly female (p = 0.048) compared with those with nonspontaneous pathology. Additionally, those with spontaneous lesions had a greater BMI than those with nonspontaneous disease (p = 0.102), although this difference did not achieve statistical significance. Thirty-two surgeries (36.0%) involved a middle fossa craniotomy alone, whereas 57 (64.0%) involved a combined mastoid–middle fossa repair. There were 7 recurrences (7.9%); 2 patients with recurrence developed meningitis. The use of artificial titanium mesh was statistically associated with the development of recurrent CSFF (p = 0.004), postoperative wound infection (p = 0.039), and meningitis (p = 0.014). Also notable, 6 of the 7 cases with recurrence had evidence of intracranial hypertension. When the 11 cases that involved using titanium mesh were excluded, 96.2% of patients whose lesions were reconstructed with an autologous multilayer repair had neither recurrent CSFF nor meningitis at the last follow-up. Conclusions Patients with temporal bone encephalocele and CSFF commonly present with persistent otorrhea and conductive hearing loss mimicking chronic middle ear disease, which likely contributes to a delay in diagnosis. There is a high prevalence of obesity among this patient population, which may play a role in the pathogenesis of primary and recurrent disease. A middle fossa craniotomy or a combined mastoid–middle fossa approach incorporating a multilayer autologous tissue technique is a safe and reliable method of repair that may be particularly useful for large or multifocal defects. Defect reconstruction using artificial titanium mesh should generally be avoided given increased risks of recurrence and postoperative meningitis.

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mentioning

confidence: 99%

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Carlson¹,

Copeland

Driscoll

et al. 2013

JNS

116

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“…As local flaps are limited in terms of size and mobility, it is difficult to reconstruct the entire EAC and cover a circumferential defect with a single local flap, necessitating dual local flaps or the concomitant use of skin grafting [Bell, 1988]. Moreover, reconstruction with local flaps alone has many shortcomings, such as contracture, stenosis, delayed wound healing, chronic infection, and bone exposure [Gal et al, 1998], resulting in conductive hearing loss and otorrhea. Meanwhile, the advantages of the freeflap methods lie in the prevention of these complications.…”

Section: Discussionmentioning

confidence: 99%

Hearing Preservation after Lateral Temporal Bone Resection for Early-Stage External Auditory Canal Carcinoma

Morita

Nakamaru²,

Homma³

et al. 2014

Audiol Neurotol

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Objective: To evaluate postoperative hearing outcomes after lateral temporal bone resection (LTBR) with reconstruction of the external auditory canal (EAC) and conductive function for early-stage EAC carcinoma. Methods: We retrospectively examined patients diagnosed with early-stage EAC carcinoma treated with surgery alone between January 2006 and December 2012. Patients who had postoperative adjuvant chemotherapy and/or radiotherapy were excluded. Patients receiving LTBR in combination with tympanoplasty were divided into two groups based on the reconstruction of the EAC with and without (w/o) split-thickness skin grafts (STSGs). Audiological data included the preoperative hearing thresholds and the most recent postoperative hearing thresholds obtained at least 12 months after surgery. The hearing outcome was evaluated based on pure-tone audiograms using the Committee on Hearing and Equilibrium guidelines of the American Academy of Otolaryngology-Head and Neck Surgery for the evaluation of the results of treatment of conductive hearing loss. The postoperative quality of life (QOL) for patients was evaluated using the Glasgow Benefit Inventory (GBI). Results: All patients (n = 15) achieved disease-free survival without significant morbidity or mortality. When we compared the mean air-bone gaps after surgery, those in the STSG group (n = 8) were found to be significantly lower than those in the w/o STSG group (n = 7; p < 0.001). The success rate for postoperative hearing was 75.0% in the STSG group, which was significantly higher than that in the w/o STSG group (p = 0.014). All patients in the w/o STSG group showed stenosis and closure of the EAC at fewer than 10 months after surgery. In contrast, all patients in the STSG group showed preserved conformation of the new EAC for more than 12 months after surgery. When we compared the mean GBI score between the two groups of patients, the overall and general health scores in the STSG group were found to be significantly higher than those in the w/o STSG group (p = 0.021, p = 0.001). Conclusions: Reconstruction of the EAC using a rolled-up STSG technique in combination with tympanoplasty after LTBR is useful for hearing preservation and the observation of locoregional lesions after surgery, resulting in improved QOL for patients. i 2014 S. Karger AG, Basel

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“…Local and regional flaps have been used for closure of such defects but when there is quite a loss of soft tissue these flaps are of no use 9,5 . Usually a pectoralis major flap is used to close massive defects concerning large amounts of soft tissue 9,5 as the main problem is the loss of soft tissue bulk.…”

Section: Discussionmentioning

confidence: 99%

“…Usually a pectoralis major flap is used to close massive defects concerning large amounts of soft tissue 9,5 as the main problem is the loss of soft tissue bulk.…”

Section: Discussionmentioning

confidence: 99%

Pacientes miológicos com defeitos extensos: opções de reconstrução. Relato de caso

Papadas

Goumas

Alexopoulou

et al. 2005

Rev. Bras. Otorrinolaringol.

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Reconstruction After Temporal Bone Resection

Cited by 56 publications

References 6 publications

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Hearing Preservation after Lateral Temporal Bone Resection for Early-Stage External Auditory Canal Carcinoma

Pacientes miológicos com defeitos extensos: opções de reconstrução. Relato de caso

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