Department of Otorhinolaryngology, University of Brescia, Piazza, Spedali Civili 1, 25100 Brescia, Italy.
Eur Arch Otorhinolaryngol. 2013 Mar;270(4):1473-9. doi: 10.1007/s00405-012-2187-0. Epub 2012 Sep 21.
Due to progressively expanded indications of endoscopic transnasal surgery, having different reconstructive options in the armamentarium becomes of paramount importance. We herein report our experience with the use of the temporo-parietal fascial flap after extended endoscopic procedures for malignancies of the clival and nasopharyngeal regions. We focus our report on the surgical anatomy of this flap and the technique for its intranasal transposition through an infratemporal corridor. The main steps of the procedure and anatomic landmarks were highlighted, thanks to previous cadaver dissection. Five patients underwent an extended endoscopic resection for malignant tumors: one with persistent clival chordoma, three with recurrent nasopharyngeal carcinomas, and 1 recurrent nasopharyngeal adenoid cystic carcinoma. In all patients a temporo-parietal fascial flap was harvested to protect critical structures or irradiated denuded bone. The Mean harvesting and hospitalization time were 120 min and 5 days, respectively. No major or minor complications were observed. Whenever local flaps are not available for oncologic reasons or previous surgery, the temporo-parietal fascial flap is a safe and relatively easy option to protect the residual skull base and critical structures such as the internal carotid artery and dura of the posterior cranial fossa, after extended endoscopic resections.
由于内镜经鼻手术适应证的不断扩大，拥有不同的重建选择变得至关重要。我们在此报告我们在颅底和鼻咽部恶性肿瘤的内镜扩大手术中使用颞顶筋膜瓣的经验。我们重点介绍了该皮瓣的手术解剖结构，以及通过颞下腔经鼻腔转移的技术。主要步骤和解剖标志通过之前的尸体解剖进行了强调。五名患者因恶性肿瘤接受了内镜扩大切除术：一名持续性颅底脊索瘤，三名复发性鼻咽癌，和 1 名复发性鼻咽腺样囊性癌。在所有患者中，均采集颞顶筋膜瓣以保护关键结构或受照射的裸露骨。平均采集和住院时间分别为 120 分钟和 5 天。没有观察到主要或次要并发症。如果由于肿瘤原因或先前的手术无法使用局部皮瓣，则在扩大内镜切除后，颞顶筋膜瓣是保护残余颅底和关键结构（如颈内动脉和颅后窝硬脑膜）的安全且相对简单的选择。
