Technique of Temporoparietal Fascia Flap in Ear and Lateral Skull Base Surgery

Stow, Nicholas W.; Gordon, D.; Eisenberg, Robert

doi:10.1097/mao.0b013e3181e3d33c

Cited by 23 publications

(13 citation statements)

References 9 publications

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“…9,25 The temporalis muscle rotation flap and the temporoparietal fascia flap provide local in-field options for repairing defects involving the mastoid and middle cranial fossa floor. Since these flaps receive their blood supply from the deep and superficial temporal arteries, respectively, it is critical to carefully plan temporal incisions to avoid loss of the anteriorly based vascular pedicles.…”

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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“…[40] The TPFF has desirable properties for otologic surgery: High malleability, distinct vascularity, and close proximity to the temporal bone. [41] We have successfully managed a case of post-infective mastoid fistula using TPFF.…”

Section: Discussionmentioning

confidence: 99%

The use of the temporoparietal fascia flap in various clinical scenarios: A review of 71 cases

Mokal¹,

Ghalme²,

Kothari³

et al. 2013

Indian J Plast Surg

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Objective:This report details our experience with the use of the temporoparietal fascia flap in different scenarios of reconstruction and to discuss our technique of harvest, clinical applications, and review of literature of this versatile flap.Materials and Methods:A retrospective study of 82 cases of temporoparietal fascia flap in 71 patients, operated over a period of 10 years was conducted. Patients were grouped based on various clinical indications. The follow up period ranged from a minimum of 1 to a maximum of 10 years (Mean-four and a half years). All patients were analyzed for functional and aesthetic outcome using preoperative and postoperative photographs.Results:No significant complications were seen in our series. Only 2 out of 82 flaps had partial necrosis of flap (2.44%). Two patients who were operated for release of submucous fibrosis developed recurrence due to continued use of tobacco. The final outcome in one patient of ear reconstruction was unsatisfactory due to flap failure. The remaining patients had satisfactory functional and aesthetic outcomes (95.77%). None had other complications like temporal branch of facial nerve injury or alopecia along the scar line.Conclusion:The TPFF is one of the most reliable and versatile flap in the head and neck region. It can also be reliably used as free fascial flap. When its advantages are combined with the surgeon's resourcefulness, various defects can be successfully reconstructed using the temporoparietal facia flap with satisfactory aesthetic and functional outcome.

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“…A pericranial flap was utilized in most cases in an obliteration technique similar to that reported by Ramsey et al (8). A temporal parieto-fascial flap was utilized in other cases (14,15). Autologous bone dust was collected and placed in areas of deep pockets or previous drainage, with care not to bury keratinized epithelium.…”

Section: Methodsmentioning

confidence: 99%

The Role of Obliteration in the Achievement of a Dry Mastoid Bowl

Harun

Clark

Semenov

et al. 2015

Otology &Amp; Neurotology

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Objective To evaluate the impact of mastoid obliteration on the achievement of a dry mastoid bowl and frequency of maintenance care. Study Design Retrospective chart review. Setting Academic medical center. Patients There were 63 canal-wall-down mastoidectomies for chronic otitis media with or without cholesteatoma between 2007 and 2014 with follow-up of at least 6 months. Eighteen mastoids were nonobliterated and 45 were obliterated. Thirteen underwent secondary obliteration of existing mastoid bowls with chronic drainage, whereas 32 underwent primary obliteration at the original canal-wall-down procedure. Intervention Mastoid obliteration. Main Outcome Measures Achievement of a dry healed mastoid cavity and frequency of outpatient visits. Results In more than 80% of the cases, a dry ear was achieved, with no significant difference between the obliterated and nonobliterated cases (p = 0.786). Eleven of the 13 secondary cases experienced cessation of otorrhea, achieving dry ears at rates similar to that of the primary and nonobliterated cases. The secondary obliteration population was also significantly younger than the primary group (22.1 versus 43.5 years, p = 0.002). Multivariable-mixed effects analysis demonstrated a reduction in 0.1 visits per 6-month period following surgery overtime (p < 0.001). Conclusions Mastoid obliteration may be valuable in the management of the well-developed and chronically wet mastoid cavity, particularly when the drainage emanates from mucosal disease or cell tracts in a deep sinodural angle. Younger patients may require secondary obliteration because of continued craniofacial maturation several years following canal-wall-down surgery.

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Technique of Temporoparietal Fascia Flap in Ear and Lateral Skull Base Surgery

Abstract: With appropriate technique and indications, the TPF flap is an important reconstructive option after ear and lateral skull base surgery.

Cited by 23 publications

References 9 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

The use of the temporoparietal fascia flap in various clinical scenarios: A review of 71 cases

The Role of Obliteration in the Achievement of a Dry Mastoid Bowl

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