Reconstructive Techniques for Temporal Bone Cancer

Abstract

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.