Reconstructive Techniques for Temporal Bone Cancer

  • Albert H. Chao
  • Matthew M. Hanasono


Reconstructive surgery is often necessary following resections of temporal bone cancers. Goals of reconstruction include providing cutaneous wound closure, coverage of dura and neurovascular structures, prevention of cerebrospinal fluid leaks, restoring facial contour, compensating for loss of facial nerve function, and supporting an auricular prosthesis. Thorough preoperative evaluation is essential in order to select the appropriate reconstructive technique. The use of adjacent tissue transfer and pedicled locoregional flaps is generally limited to smaller defects. Microvascular free flaps are often necessary for larger defects, especially when there is significant dead space, in previously irradiated or operated fields, or when critical neurovascular structures are exposed. While the free rectus abdominis myocutaneous flap has previously been commonly used for temporal bone reconstruction, more recently the free anterolateral thigh flap has become favored, in part because of its more suitable flap thickness and minimal donor site morbidity. When cranial nerves must be transected, nerve reconstruction and rehabilitation should be considered, especially for the facial nerve. The postoperative monitoring and care of patients who undergo reconstructive surgery for temporal bone defects are essential to ensure flap survival and optimize wound healing.


Flap Free flap Local flap Microsurgery Microvascular Pedicled flap Plastic surgery Reconstruction Reconstructive surgery 


  1. 1.
    Hanasono MM, Silva AK, Yu P, Skoracki RJ, Sturgis EM, Gidley PW. Comprehensive management of temporal bone defects after oncologic resection. Laryngoscope. 2012;122(12):2663–9.CrossRefGoogle Scholar
  2. 2.
    Marzo SJ, Benscoter B, Leonetti JP. Contemporary options for lateral skull base reconstruction following tumor extirpation. Curr Opin Otolaryngol Head Neck Surg. 2011;19(5):330–4.CrossRefGoogle Scholar
  3. 3.
    Moffat DA, Grey P, Ballagh RH, Hardy DG. Extended temporal bone resection for squamous cell carcinoma. Otolaryngol Head Neck Surg. 1997;116:158–60.CrossRefGoogle Scholar
  4. 4.
    Moore BA, Wine T, Netterville JL. Cervicofacial and cervicothoracic rotation flaps in head and neck reconstruction. Head Neck. 2005;27:1092–101.CrossRefGoogle Scholar
  5. 5.
    Patel R, Buchmann LO, Hunt J. The use of the temporoparietal fascial flap in preventing CSF leak after lateral skull base surgery. J Neurol Surg B Skull Base. 2013;74(5):311–6.CrossRefGoogle Scholar
  6. 6.
    Smith JE, Ducic Y, Adelson RT. Temporalis muscle flap for reconstruction of skull base defects. Head Neck. 2010;32(2):199–203.PubMedGoogle Scholar
  7. 7.
    Stow NW, Gordon DH, Eisenberg R. Technique of temporoparietal fascia flap in ear and lateral skull base surgery. Otol Neurotol. 2010;31(6):964–7.CrossRefGoogle Scholar
  8. 8.
    Hanasono MM, Utley DS, Goode RL. The temporalis muscle flap for reconstruction after head and neck oncologic surgery. Laryngoscope. 2001;111:1719–25.CrossRefGoogle Scholar
  9. 9.
    Gal TJ, Kerschner JE, Futran ND, Bartels LJ, Farrior JB, Ridley MB, Klotch DW, Endicott JN. Reconstruction after temporal bone resection. Laryngoscope. 1998;108(4 Pt 1):476–81.CrossRefGoogle Scholar
  10. 10.
    McLean JN, Carlson GW, Losken A. The pectoralis major myocutaneous flap revisited: a reliable technique for head and neck reconstruction. Ann Plast Surg. 2010;64(5):570–3.PubMedGoogle Scholar
  11. 11.
    Howard BE, Nagel TH, Barrs DM, Donald CB, Hayden RE. Reconstruction of lateral skull base defects: a comparison of the submental flap to free and regional flaps. Otolaryngol Head Neck Surg. 2016;154:1014–8.CrossRefGoogle Scholar
  12. 12.
    Miller C, Hanley JC, Gernon TJ, Erman A, Jacob A. The submental island flap for reconstruction of temporal bone defects. Otol Neurotol. 2015;36(5):879–85.CrossRefGoogle Scholar
  13. 13.
    Hunt JP, Buchmann LO. The supraclavicular artery flap for lateral skull and scalp defects: effective and efficient alternative to free tissue transfer. J Neurol Surg Rep. 2014;75(1):e5–10.CrossRefGoogle Scholar
  14. 14.
    Kokot N, Mazhar K, Reder LS, Peng GL, Sinha UK. Use of the supraclavicular artery island flap for reconstruction of cervicofacial defects. Otolaryngol Head Neck Surg. 2014;150(2):222–8.CrossRefGoogle Scholar
  15. 15.
    Disa JJ, Rodriguez VM, Cordeiro PG. Reconstruction of lateral skull base oncological defects: the role of free tissue transfer. Ann Plast Surg. 1998;41(6):633–9.CrossRefGoogle Scholar
  16. 16.
    Hanasono MM, Silva A, Skoracki RJ, Gidley PW, DeMonte F, Hanna EY, Chang DW, Yu P. Skull base reconstruction: an updated approach. Plast Reconstr Surg. 2011;128(3):675–86.CrossRefGoogle Scholar
  17. 17.
    Rosenthal EL, King T, McGrew BM, Carroll W, Magnuson JS, Wax MK. Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects. Head Neck. 2008;30(5):589–94.CrossRefGoogle Scholar
  18. 18.
    Teknos TN, Smith JC, Day TA, Netterville JL, Burkey BB. Microvascular free tissue transfer in reconstructing skull base defects: lessons learned. Laryngoscope. 2002;112:1871–6.CrossRefGoogle Scholar
  19. 19.
    O’Connell DA, Teng MS, Mendez E, Futran ND. Microvascular free tissue transfer in the reconstruction of scalp and lateral temporal bone defects. J Craniofac Surg. 2011;22(3):801–4.CrossRefGoogle Scholar
  20. 20.
    Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg. 2010;125(1):209–14.CrossRefGoogle Scholar
  21. 21.
    Corbitt C, Skoracki RJ, Yu P, Hanasono MM. Free flap failure in head and neck reconstruction. Head Neck. 2014;36:1440–5.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Ohio State University Plastic SurgeryColumbusUSA
  2. 2.Department of Plastic SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

Personalised recommendations