Anterior Skull Base Reconstruction following Ablative Surgery for Osteoradionecrosis: Case Report and Review of Literature

Katya Chapchay*, Jeffrey Weinberger, Ron Eliashar, Neta Adler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Introduction: Osteoradionecrosis is one of many potentially severe complications of radiotherapy for nasopharyngeal carcinoma. Osteoradionecrosis of the skull base is life-threatening due to the critical proximity of the pathological process to vital structures, for example, the intracranial cavity, the upper spine, and major blood vessels. Reconstructive options following surgical debridement of the anterior skull base and upper spine osteonecrosis have been scarcely described in the literature. Case presentation and management: We present a rare case of osteoradionecrosis of the clivus and cervical vertebrae C1-C2 in a patient previously treated with chemoradiotherapy for nasopharyngeal carcinoma, presenting as severe soft tissue infection of the neck. Aggressive surgical debridement and reconstruction with a two-paddle free anterolateral thigh flap was performed using a combination of transcervical and transnasal endoscopic approaches. A novel endoscopic procedure in the sphenoid sinus enabled flap anchoring in this complex area. Discussion: Surgical modalities for osteoradionecrosis of the skull base and upper spine are discussed and review of the literature is presented. Conclusion: Reconstruction of the anterior skull base with a well-vascularized free flap following ablative surgery should be considered in management of life-threatening osteoradionecrosis of the area. Endoscopic opening of the sphenoid sinus and creating a funnel-shaped stem is a newly described technique that guarantees precise placement of the flap and is a valuable adjunct to the reconstructive armamentarium.

Original languageAmerican English
Pages (from-to)1134-1140
Number of pages7
JournalAnnals of Otology, Rhinology and Laryngology
Volume128
Issue number12
DOIs
StatePublished - 1 Dec 2019

Bibliographical note

Publisher Copyright:
© The Author(s) 2019.

Keywords

  • anterolateral thigh flap
  • endoscopic sinus surgery
  • nasopharyngeal carcinoma
  • osteoradionecrosis
  • skull base reconstruction

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