[Reconstruction of the frontobasal skull after tumor operations and trauma. Transplant selection and functional outcome]

Abstract

Defects of the frontoorbital complex subsequent to extensive tumor surgery or severe trauma often result in aesthetic and functional disharmonies. The long-term results of rehabilitation related to different materials and techniques are the subject of this study. From 1974 to 1996 altogether 127 patients with bony defects of the orbit and/or the skull base underwent surgery. All patients' data were documented prospectively from 1984 onwards. The results following reconstruction with autologous calvarian transplants in 52 patients were compared to those of a control group which received iliac bone or PMMA implants. Eighty-one bony defects (64%) resulted from tumor resection; 37 patients (29%) suffered from the effects of trauma. In 67 cases (53%) reconstruction was performed primarily, in 51 cases (40%) secondarily. Free or pedicled soft-tissue transplants were necessary in order to separate the orbit and the neurocranium in 26% of the defects. On the other hand, small, isolated defects of the orbital roof (7%) were left without any reconstructive procedure. Contrary to the iliac bone grafts, the calvarian transplants resisted secondary resorption. Postoperative infections appeared in two cases; loss of transplants was avoided entirely in the group of calvarian reconstructions in contrast to the alloplasts. The selection of a suitable donor site area and rigid fixation with microplates led to excellent esthetic results even in cases with large defects.