The Clinical Analysis Of Reconstruction After The Cranio-maxillofacial Tumors Resection Involving The Skull Base

Objective : To explore the way and technique of reconstruction after the cranio-maxillofacial tumors resection involving the skull base and to evaluate the effects of these treatments for the purpose of reducing the incidence of complication and improving the postoperative appearance and the quality of life and survival.Methods and materials:Retrospectively analyse the clinical date of 30 patients with cranio-maxillofacial tumors involving the skull base between 2010 and 2015 in the oral- maxillofacial department of Affiliated 1st Hospital of Fujian Medical University. Malignant tumor 19 cases, benign tumor 10 cases, border tumor 1 case. According to the location and extent of skull base invasions, tumors that involved the skull base were divided into several types: anterior skull base 10 cases, middle skull base 5 cases, posterior skull base 1 case, lateral skull base 14 cases; skull base bone defect 6 cases, none 24 cases; endocranium defect 4 cases, none 26 case. According to the nature, location and size of tumors, appropriate surgical approaches should be selected; The defects after cranio-maxillofacial resection were reconstructed immediately with adjacent, local or regional tissue flaps and free microscopic vascularized tissue flaps according to the size, location and extent of different defects; titanium mesh was chosen to reconstruct those big skull base bone defects, and repair the endocranium defect with autogenous fascias or artificial materials.Results:All patients' cranio-maxillofacial tumors were resected completely and reconstructed successfully, Without any intraoperative complication. With 8 adjacent tissue flaps, 10 local or regional tissue flaps and 11 free microscopic vascularized tissue flaps(all were ALT flaps), 1 free flap, 7 titanium meshes, 2 artificial dural materials and 1 pericranium. Postoperative complications included: 2 of 11 anterolateral thigh( ALT) flaps got necrotic(One patient has underwent operation and chemotherapy), 4 patients got pneumonia, 1patient had headache and intracranial hematoma, 1 patient got subcutaneous hydrops, 3 patients got undesirable healing wounds; No complications such as cerebrospinal fluid fistula, meningoencephalocele, intracranial inflection, pneumocrania, epilepsy and so on were observed. The overall rate of complications was 36.7%, and the dead rate was 0.Conclusions: The indication and contraindication of the cranio-maxillofacial tumors resection involving the skull base should always be mastered strictly; According to the nature, location and size of tumors,appropriate approaches should be selected; Through the cooperation of multidisciplinary, the proper way and technique of reconstruction should be selected; extracranial and intracranial tissues can be successfully isolated safely and effectively; can do recover the appearance and artistry, do reduce the incidence of complication and increase the quality of living and life postoperatively. For the reconstruction of the cranio-maxillofacial enormous defects involving the skull base, anterolateral thigh( ALT) flaps can be considered preferentially.