Tina and Rick Caruso Department of Otolaryngology and Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
University of Tel Aviv, Sackler Faculty of Medicine, Tel Aviv, Israel.
J Craniomaxillofac Surg. 2018 Oct;46(10):1856-1861. doi: 10.1016/j.jcms.2018.08.002. Epub 2018 Aug 11.
Reconstruction after temporal bone resection (TBR) is challenging due to the lack of consensus on an optimal approach. Records of the Keck Hospital of USC were searched to identify, collect and group data on patients who underwent TBR for malignancy. Chi-square analysis was used for categorical variables, and ANOVA was used for continuous variables. Forty TBR including 27 lateral (LTBR), 8 total (TTBR), and 5 subtotal (STBR) temporal bone resections were performed at our institution over a ten year time period (2003-2013) and reconstructed with free, regional, and local flaps and tissue grafts. TTBR was associated with postoperative complications as was presence of a dural defect, though other traditionally poor prognostic factors such as age, comorbidity status, and history of irradiation were not. Patients who underwent auriculectomy or parotidectomy were more likely to require free flap reconstruction. We conclude that TBR and reconstruction can be performed successfully on many patients including those who are older or who have more aggressive disease. We recommend free tissue transfer for the large defects created by TTBR, parotidectomy and auriculectomy.
由于缺乏关于最佳方法的共识，颞骨切除 (TBR) 后的重建具有挑战性。我们检索了南加州大学凯克医院的记录，以确定、收集和分组接受 TBR 治疗恶性肿瘤的患者的数据。卡方分析用于分类变量，方差分析用于连续变量。在 10 年时间内（2003-2013 年），我们在本机构进行了 40 例 TBR，包括 27 例外侧 (LTBR)、8 例全颞骨 (TTBR) 和 5 例次全颞骨 (STBR) 切除，并使用游离、区域和局部皮瓣和组织移植物进行重建。尽管其他传统的预后不良因素，如年龄、合并症状况和放疗史，并非如此，但 TTBR 后出现术后并发症和硬脑膜缺损与 TTBR 后出现术后并发症有关。接受耳切除术或腮腺切除术的患者更可能需要游离皮瓣重建。我们得出结论，许多患者包括年龄较大或疾病更具侵袭性的患者都可以成功地进行 TBR 和重建。我们建议对 TTBR、腮腺切除术和耳切除术引起的大缺损进行游离组织转移。
