The Importance of Flaps in Reconstruction of Locoregionally Advanced Lateral Skull-Base Cancer Defects: A Tertiary Otorhinolaryngology Referral Centre Experience

Abstract

OBJECTIVE: To identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer.

METHODS: Retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre.

RESULTS: Twelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75 %), partial parotidectomy in six (50 %), total parotidectomy in one (8.3 %), ipsilateral selective neck dissection in eight (66.7 %) and ipsilateral modified radical neck dissection in one patient (8.3 %). The defect was reconstructed with anterolateral thigh free flap (17 %), radial forearm free flap (17 %) or pectoralis major myocutaneous flap (17 %). Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100 %. At the data collection cut-off, 83 % of analysed patients and 100 % of patients with flap reconstruction were alive.

CONCLUSIONS: Favourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.

KEYWORDS: Temporal Bone – Microsurgery – Parotid Region – Free Tissue Flaps – Neoplasm Staging – Ear