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Reconstruction of the Lateral Skull Base
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
7 sections · 95 slides
The reconstructive problem
- Scope of lateral skull base reconstruction
- Obstacles to durable closure
- Consequences of auricular loss
- Structure of this topic
Defect considerations
- Categorising the ablative procedure
- Lateral temporal bone resection
- Subtotal temporal bone resection
- Total temporal bone resection
- Escalating extent of temporal bone resection
- Lateral view of the temporal bone
- Indications for partial or total auriculectomy
- Blood supply of the auricle
- Loss of bony support for the auricle
- Functional and aesthetic assessment before auriculectomy
- Timing of osseointegrated implants after radiotherapy
- Zygoma, lateral orbit and midfacial width
- Medial extension to mastication and mandible
Wound considerations
- Patient factors affecting wound healing
- Defect location: coronal and axial relationships
- Implications of defect position
- Classification of defects by landmark
- Dural exposure after temporal bone resection
- Infection risk with exposed dura
- Obliteration and cranioplasty policy
- Dural resection with middle or posterior fossa CSF leak
Local reconstructive options
- Criteria before attempting primary closure
- Venous congestion and delayed necrosis
- Free fat and dermal fat grafts
- Cervicofacial and cervicothoracic rotation flaps
- Plane of elevation and flap vascular pattern
- Temporalis muscle anatomy
- Blood supply of the temporalis muscle
- Temporalis rotation flap: harvest
- Increasing the arc of rotation and resurfacing
- Temporalis rotation flap with split-thickness skin graft
- Donor site morbidity of the temporalis flap
- Indications and contraindications for the temporalis flap
- Reported wound outcomes with the temporalis flap
Regional pedicled options
- Pectoralis major muscle anatomy
- Pedicle of the pectoralis major myocutaneous flap
- Division of the pectoral nerves
- Skin paddle design in the pectoralis major flap
- Elevation and transfer of the pectoralis major flap
- Modifications to increase reach
- Pectoralis major myocutaneous flap after total auriculectomy
- Advantages of the pectoralis major flap
- Limitations of the pectoralis major flap
- Trapezius muscle anatomy
- Blood supply of the lower island trapezius flap
- Harvest of the lower island trapezius flap
- Advantages of the lower island trapezius flap
- Limitations of the lower island trapezius flap
- Pedicled flap reach compared
- Supraclavicular island flap: vascular basis
- Identifying the supraclavicular pedicle
- Raising the supraclavicular island flap
- Advantages of the supraclavicular island flap
- Limitations of the supraclavicular island flap
Free tissue transfer
- Indications for free tissue transfer
- Transverse rectus abdominis myocutaneous flap
- Radial forearm fasciocutaneous flap: basis
- Venous drainage and sensation of the radial forearm flap
- Arteries of the forearm and hand
- Preoperative assessment before radial artery harvest
- Radial forearm flap harvest
- Donor site closure after radial forearm harvest
- Strengths and limits of the radial forearm flap
- Anterolateral thigh flap: vascular anatomy
- Anterolateral thigh flap harvest
- Versatility and pedicle of the anterolateral thigh flap
- Anterolateral thigh flap for a total auriculectomy defect
- Limitations of the anterolateral thigh flap
- Indications for vascularised bone
- Fibula free flap: characteristics
- Tibia and fibula, anterior view
- Fibula for mandibular condyle reconstruction
- Subscapular system: constituent flaps
- Choosing the subscapular system over the fibula
- Latissimus dorsi and subscapular donor morbidity
Putting it together
- Sequence of reconstructive decisions
- Reconstructive options by tissue requirement
- Conclusions
- References
- References (continued)
- References (continued)
- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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