Reconstructive Techniques in Skull Base Surgery for Head and Neck Malignancies

Introduction: Skull base surgery is increasingly an option in the surgical management of head and neck cancer. Mortality and morbidity is principally determined by the reconstructive result. We present our experience-based approach to reconstruction of such skull base defects. Method: We reviewed case notes of all the patients who underwent craniofacial surgery and reconstruction for malignancies in our center. Results: Overall 43 patients underwent craniofacial resection (n = 30) or petrosectomy (n = 13). Pathologies were squamous cell carcinoma of external ear (n = 12), adenoid cystic carcinoma (n = 7), SCC of sinonasal origin (n = 7) and others (n = 17). Total 16 patients (37%) had postoperative morbidity. Overall 25 patients underwent reconstruction using free flaps and 18 had rotational flaps, with flap failure/revision rate being 12% for free flaps and 5.5% for rotational flaps. Around 62.5% of complications were directly or indirectly reconstruction related. Conclusion: Our current algorithm includes local galea flap for limited anterior cranial fossa resections, temporalis if also orbital exenteration and rectus free flap for petrosectomy. We routinely use in situ flap fixation, pericranial “double-breasting,” lumbar CSF drainage and free flaps in a postradiotherapy context. Optimizing the reconstructive outcome is important if skull base resection techniques are to be extended to cancers not involving the skull base but for which such skull base techniques are likely to improve free margins.