Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York.
Microsurgery. 2019 Mar;39(3):259-262. doi: 10.1002/micr.30363. Epub 2018 Sep 3.
We report a case during which a new method of reconstruction for a nasopharyngeal and skull base defect was successfully performed. A 45-year-old female with granulomatosis with polyangiitis presented with computed tomography (CT) findings demonstrative of chronic clival and cervical spine osteomyelitis secondary to nasopharyngeal destruction. The posterior nasopharyngeal defect, evident as a wide area of mucosal erosion exposing the clivus centrally, was successfully reconstructed with an anterior serratus muscle-free tissue transfer via both transcervical and endoscopic transnasal approaches utilizing a laparoscopic fixation device, a previously unreported method for free flap inset, to secure the free flap. The patient tolerated this well and no major complications were encountered. At 2-year follow-up, the patient was without signs of cerebrospinal fluid leak or sequelae of infectious complications, including meningitis and osteomyelitis. A combined transcervical and endoscopic transnasal approach using a laparoscopic fixation device for free flap inset can be an effective method to reconstruct posterior nasopharyngeal defects in those patients whom local reconstructive options are not available.
我们报告了一例成功实施的新方法来重建鼻咽和颅底缺损的病例。一位 45 岁的女性患有肉芽肿性多血管炎，其计算机断层扫描（CT）结果显示，由于鼻咽部破坏，导致慢性斜坡和颈椎骨髓炎。通过经颈和经鼻内镜联合应用腹腔镜固定装置，成功地对后鼻咽部缺损进行了重建，该缺损表现为广泛的黏膜侵蚀，使中颅底暴露。这是一种以前未曾报道过的游离皮瓣置入方法，用于固定游离皮瓣。患者耐受良好，未出现重大并发症。在 2 年的随访中，患者没有脑脊液漏或感染并发症（包括脑膜炎和骨髓炎）的迹象。对于那些局部重建方法不可用的患者，使用腹腔镜固定装置进行经颈和经鼻内镜联合应用的游离皮瓣置入方法可以是一种有效的重建后鼻咽部缺损的方法。
