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Head and Neck Surgery

(294) Literature Review: Reconstruction of Anterior Skull Base

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Nuwan Meegalla, MD

    Resident Physician
    Wake Forest School of Medicine
    Winston Salem, North Carolina, United States

    • Co-Author(s)

  • Kunjan B. Patel, MD

    Resident
    Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine
    Winston Salem, North Carolina, United States

  • Kenneth Feehs, MD

    Resident
    Wake Forest School of Medicine
    Winston Salem, North Carolina, United States

  • JP

    Jacline Phillips, MD

    PGY-5, Chief Resident
    Wake Forest Baptist Medical Center
    Winston Salem, North Carolina, United States

    • Senior Author(s)

  • AS

    Allison A. Slijepcevic, MD

    Assistant Professor
    Wake Forest University School of Medicine, USA

  • Srinivasa R. Chandra, MD, BDS, FACS

    Associate Professor and Program Director, OHSU
    Department of Oral Maxillofacial Surgery, Oregon Health Science University
    Mercer Island, Washington, United States

Disclosure(s):
Nuwan Meegalla, MD: No relevant relationships to disclose.
Kunjan B. Patel, MD: No relevant relationships to disclose.
Kenneth Feehs, MD: No relevant relationships to disclose.
Jacline Phillips, MD: No relevant relationships to disclose.


Introduction: Anterior skull base defects are often complex and involve multiple tissue layers, and pose challenges to the reconstructive surgeon. As endoscopic sinus surgery has become the mainstay of surgical ablation for anterior skull base tumors, a variety of reconstructive methods exist, ranging from synthetic materials to locoregional flap reconstruction. When resection is not compatible with endoscopic management, open approaches become required. Our study seeks to illustrate the reconstructive methods for anterior skull base defects.

Methods: A literature review was performed by using the PubMed database search. Studies included range from 2005 to 2022. These studies were analyzed and the results were collated and presented in our study.

Results: A range of reconstructive methods exist for anterior skull base defects, including synthetic grafts that are amenable to small defects of the sella often associated with endoscopic endonasal surgery. Moderate size defects are commonly reconstructed with the nasoseptal flap, however a broad range of novel local flaps using nasal tissues exist to reconstruct defects in areas with poor nasal septal tissue, including the inferior/middle turbinate flaps, turbinal flap, and septal flip flap. Large defects following craniofacial resection for malignant pathologies are best reconstructed with autologous free tissue flaps that provide vascularized muscle capable of sealing the intracranial vault from the sinonasal cavity in addition to preventing a CSF leak.

Conclusions: There is no consensus on size of anterior skull base defects in the literature, although several algorithms have been posited. Upon searching the literature, it seems that generally small defects can be reconstructed with synthetic grafts. Moderate sized defects are typically reconstructed with nasoseptal flaps, but this can be in addition to inferior/middle turbinate flaps, turbinal flaps, or a septal flip flap. Larger defects are reconstructed with free tissue transfer that provide a seal between the intracranial space and the sinonasal cavity in addition to preventing a CSF leak.