The ability to reliably reconstruct complex and sizable wounds has decreased the morbidity of skull base surgery substantially, preventing major complications and allowing treatment of tumors previously considered inoperable. Addressing facial nerve function with static and dynamic procedures as well as fabrication of craniofacial prostheses to replace delicate facial landmarks has further increased surgeons’ ability to restore the appearance and function of the face.
Key points
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The goals of craniofacial reconstruction following skull base surgery include creating a watertight dural seal, providing a barrier between the dura and the aerodigestive tract, supporting the orbit, and restoring facial appearance and function.
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Classifying skull base lesions into regions based on key anatomic structures helps to predict the reconstructive needs and outcomes.
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Repair and rehabilitation of the facial nerve, if resected, must be considered in the reconstructive approach.
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Prosthetic rehabilitation may be the most appropriate way of replacing resected facial structures such as the eye, nose, or ear, or may be used while awaiting autologous tissue reconstruction.
Introduction
Neoplasms involving the skull base are among the most challenging tumors to treat. The complex anatomy of the region makes resection difficult and places the patient at risk for major complications, such as cerebrospinal fluid (CSF) leak, meningitis, and osteomyelitis. Craniofacial reconstructions that minimize the risks for such complications as well as restore facial appearance and function have become a critical part of most skull base surgeries ( Box 1 ). Although, historically, skull base resections were associated with poor outcomes, advances in reconstruction, which minimize complications, loss of function, and disfigurement, concomitant with advances in oncologic resection, radiation, chemotherapy, and diagnostic and interventional radiology, have substantially decreased the morbidity as well as increased the efficacy of skull base tumor treatment.
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