Reconstruction strategy for temporal bone and lateral facial defects

Abstract

Large or recurrent tumors of the auricular and parotid areas sometimes require resections involving the temporal bone and adjacent structures, including the facial nerve, the auditory apparatus, ascending ramus of the mandible, and the temporomandibular joint. At times, these resections can include the skull and even the underlying dura. Although these massive resections can provide good palliation and sometimes cure for these advanced patients, incumbent on the strategy for this treatment is a reliable one-stage technique for repair of the resultant defect. We have found the use of free-tissue transfer and the pectoralis muscle flap to be useful in the reconstruction of these defects. The pectoralis muscle flap is used when the defect is at or inferior to the external auditory meatus. More cephalad lesions require free-tissue transfer; for small surface area defects, the free scapular flap has been found to be useful, whereas for larger surface area defects, the free latissimus muscle flap with overlying skin graft has been used with good success. This paper is a report of our experience with this strategy in 14 patients. Our results are discussed and 3 patients are presented.