Reconstruction of the Anterior Cranial Base with the Galeal Frontalis Myofascial Flap and the Vascularized Outer Calvarial Bone Graft

Abstract

Reconstruction of the anterior cranial base after tumor extirpation must seal off the cranial cavity from the upper respiratory tract. The key to success is to use vascularized materials for the structural support of the brain. From October 1989 to July 1992, 10 patients underwent anterior cranial base reconstruction after basicranial tumor resection; the lesions were four meningiomas and six malignant tumors of the ethmoid, maxilla, and orbit. The malignant tumors included four recurrent tumors that had been previously treated by a transfacial approach. After tumor extirpation, the resultant bony defects in the anterior cranial base, involving the orbital roof as well as the cribriform plate, ranged from 4 x 3 to 6 x 7 cm in size. The materials used in reconstruction were the galeal frontalis myofascial flap and the outer table calvarial bone flap, which is based on the temporoparietal galeal flap. Both materials are known to have rich blood supplies. These flaps make a reliable separation between the cranial cavity and the respiratory tract in three layers: the galeal frontalis myofascial flap, the vascularized calvarial bone, and the temporoparietal galea. Postoperative complications included one subcutaneous hematoma and one temporary cerebrospinal fluid rhinorrhea. We think this reconstructive technique will be useful in selected circumstances, especially after resection of a recurrent malignant tumor.

Definitive Treatment of Persistent Frontal Sinus Infections: Elimination of Dead Space and Sinonasal Communication

“…Currently, the only vascularized option for sinus obliteration is a local flap, such as the galeal frontalis, pericranial, or transverse glabellar. 17,24,67 Galeal flaps and other local vascularized flaps have donor-site morbidity and, like calvarial grafts, are likely unavailable following previous surgical attempts. 8 The Riedel procedure is an alternative approach that achieves sinus ablation through complete removal of the anterior table.…”

Split Calvarial Graft to Repair the Large Frontal Bone Defect

“…The options to reconstruct the dural include free autografts (e.g. fascia lata and temporalis fascia) and vascularized flaps (i.e., free muscular flaps, pericranial or galeal flaps), assuming that an overlying vascular tissue will provide the long-term viability of the fascial graft [6,13].…”

Combination of vascularized outer-table calvarial bone graft based on the superficial temporal vessels and allomatrix for the repair of an orbito-frontal blow-out fracture in a child

“…Free grafts are prone to resorption. Synthetic materials and nonvascularized grafts when used in areas with poorly vascularized tissues or in contact with a dural graft Orbito-frontal blow-out fracture in a child 327 have a very high risk of infection and can cause delayed wound healing (Hasegawa et al, 1995). In craniofacial surgery where the dura is breached, or where the possibility of a communication between the dural space and the nasopharynx or the neighbouring paranasal sinuses exists, vascularized tissues are preferred for reconstruction (Jackson et al, 1986;Matsuba et al, 1990;Carstens et al, 1991).…”