J Neurol Surg B Skull Base 2022; 83(02): 159-166
DOI: 10.1055/s-0040-1718764
Original Article

Transinfratemporal Fossa Transposition of the Temporalis Muscle Flap for Skull Base Reconstruction after Endoscopic Expanded Nasopharyngectomy: Anatomical Study and Clinical Application

Xicai Sun*
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Quan Liu*
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Hongmeng Yu*
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Huan Wang*
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Weidong Zhao
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Yurong Gu
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Houyong Li
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Keqing Zhao
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Xiaole Song
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Dehui Wang
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Juan C. Fernandez Miranda
2   Department of Neurosurgery, Stanford University Medical Center, Stanford, California, United States
,
Carl H. Snyderman
3   Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Funding This project was funded by Shanghai Hospital Development Center (SHDC12018118), New Technologies of Endoscopic Surgery in Skull Base Tumor: CAMS Innovation Fund for Medical Sciences (CIFMS) (12M-5-003), and Shanghai Municipal Health Commission (201940143).

Abstract

Objective Temporalis muscle flap (TMF) is widely used in traditional skull base surgery, but its application in endoscopic skull base surgery remains rarely reported. We aimed to investigate the surgical anatomy and clinical application of TMF for reconstruction of skull base defects after expanded endoscopic nasopharyngectomy.

Methods Nine fresh cadaver heads (18 sides) were used for endoscopic dissection at the University of Pittsburgh School of Medicine in the United States. TMF was harvested using a traditional open approach and then transposed into the maxillary sinus and nasal cavity through the infratemporal fossa using an endoscopic transnasal transmaxillary approach. TMF length was then measured. Moreover, TMF was used for the reconstruction of skull base defects of six patients with recurrent nasopharyngeal carcinoma after expanded endoscopic nasopharyngectomy.

Results The length of TMF harvested from the temporal line to the tip of the coronoid process of the mandible was 11.8 ± 0.9 cm. The widest part of the flap was 9.0 ± 0.4 cm. When TMF was dislocated from the coronoid process of the mandible, approximately another 2 cm of reach could be obtained. When the superficial layer of the temporalis muscle was split from the deep layer, the pedicle length could be extended 1.9 ± 0.2 cm. TMF could cover skull base defects in the anterior skull base, sellar, and clivus regions.

Conclusion TMF can be used to reconstruct skull base defects after endoscopic expanded nasopharyngectomy and can effectively prevent the occurrence of serious complications in patients with recurrent nasopharyngeal carcinoma.

* These authors equally contributed to this article.




Publication History

Received: 11 September 2019

Accepted: 19 August 2020

Article published online:
11 May 2021

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