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Reconstruction and Facial Reanimation After Temporal Bone Resection: A Multi-Institution Experience
John F Ryan1, Stephen P Hadford2, Jason C Nellis1
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Background:
Temporal bone resection (TBR) may result in large defects and facial nerve sacrifice.
Methods:
Retrospective review of adults undergoing TBR from 2008 to 2019.
Results:
One hundred and forty patients were reviewed. The extent of TBR was lateral (n = 135), subtotal (n = 2), and total (n = 3). Defects were reconstructed with free flaps (n = 72), regional flaps (n = 45), and cervicofacial flaps (n = 31). Complications included wound dehiscence (n = 20), infection (n = 15), hematoma (n = 6), cerebrospinal fluid leak (n = 2), and meningitis (n = 1). Smoking history was associated with wound complications (OR = 1.23, p = 0.03). Prior resection (OR = 2.34, p = 0.03) and advanced T stage (OR = 1.38, p = 0.04) were associated with free flap reconstruction. Forty-seven patients underwent facial nerve sacrifice. Facial reanimation techniques included primary neurorrhaphy (n = 2), interposition nerve grafting (n = 28), masseteric (n = 7), or hypoglossal (n = 5) to nerve transfers, temporalis tendon transfer (n = 21), ectropion repair (n = 31), brow lift (n = 21), and upper eyelid loading (n = 40).
Conclusion:
Advanced T stage and re-resection are associated with free flap reconstruction after TBR.
