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Skull base surgery. 2000; 10(2): 65–70.
PMCID: PMC1656764

Experience with 24 Cases of Reconstructive Anterior Skull Base Surgery

Classification and Evaluation of Postoperative Facial Appearance


This article details our experience with 24 cases of anterior skull base reconstruction after tumor resection. They were classified into four types according to the resected region. In 11 cases of type I resection, the orbital part of frontal bone and/or cribriform plate of ethmoid bone were resected. In two cases of type II resection, the orbital contents and partial orbital bone were resected with the addition of type I. In five cases of type III resection, the maxillary bone was resected with the addition of type II. In six cases of type IV resection, the zygomatic bone and/or facial skin were resected with the addition of type III. The tumor originating from intracranial region was 25% of this series and all of them belonged to type I. The tumor originating from extracranial region tumor was 75% and its resected region was more extensive. In type I and II resections, the cranial flap, radial forearm free flap, or a combination of the two was used for reconstruction. The rectus abdominis myocutaneous/muscle free flap was used for reconstruction of massive defects in type III and IV defects. Total incidence of postoperative complications was 16.7%. Donor site deformity of the cranial flap at the frontal and temporal region in types I and II resections and facial contour deformity in zygomatic region and defect of upper and/or lower palpebra in type IV resection were major problems with postoperative facial appearance. Although use of the rectus abdominis myocutaneous free flap combined with costal cartilages improved the midfacial contour, palpebral reconstruction remained an unsolved problem in reconstructive skull base surgery. The reconstructive goals in skull base surgery are not only to obtain safe and reliable skull base reconstruction but also to restore the facial appearance postoperatively.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Shah JP, Galicich JH. Craniofacial resection for malignant tumors of ethmoid and anterior skull base. Arch Otolaryngol. 1977 Sep;103(9):514–517. [PubMed]
  • Schramm VL, Jr, Myers EN, Maroon JC. Anterior skull base surgery for benign and malignant disease. Laryngoscope. 1979 Jul;89(7 Pt 1):1077–1091. [PubMed]
  • Johns ME, Winn HR, McLean WC, Cantrell RW. Pericranial flap for the closure of defects of craniofacial resection. Laryngoscope. 1981 Jun;91(6):952–959. [PubMed]
  • Horowitz JH, Persing JA, Nichter LS, Morgan RF, Edgerton MT. Galeal-pericranial flaps in head and neck reconstruction. Anatomy and application. Am J Surg. 1984 Oct;148(4):489–497. [PubMed]
  • Jones NF, Sekhar LN, Schramm VL. Free rectus abdominis muscle flap reconstruction of the middle and posterior cranial base. Plast Reconstr Surg. 1986 Oct;78(4):471–479. [PubMed]
  • Arden RL, Mathog RH, Thomas LM. Temporalis muscle-galea flap in craniofacial reconstruction. Laryngoscope. 1987 Nov;97(11):1336–1342. [PubMed]
  • Jones NF, Schramm VL, Sekhar LN. Reconstruction of the cranial base following tumour resection. Br J Plast Surg. 1987 Mar;40(2):155–162. [PubMed]
  • Snyderman CH, Janecka IP, Sekhar LN, Sen CN, Eibling DE. Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope. 1990 Jun;100(6):607–614. [PubMed]
  • Yamada A, Harii K, Ueda K, Asato H. Free rectus abdominis muscle reconstruction of the anterior skull base. Br J Plast Surg. 1992 May-Jun;45(4):302–306. [PubMed]
  • Izquierdo R, Leonetti JP, Origitano TC, al-Mefty O, Anderson DE, Reichman OH. Refinements using free-tissue transfer for complex cranial base reconstruction. Plast Reconstr Surg. 1993 Sep;92(4):567–575. [PubMed]
  • Yamamoto Y, Minakawa H, Yoshida T, Igawa H, Sugihara T, Ohura T, Nohira K. Role of bone graft in reconstruction of skull base defect: is a bone graft necessary. Skull Base Surg. 1993;3(4):223–229. [PMC free article] [PubMed]
  • Yamamoto Y, Sugihara T, Kuwahara H, Qi F. An anatomic study for the rectus abdominis myocutaneous flap combined with a vascularized rib. Plast Reconstr Surg. 1995 Nov;96(6):1336–1340. [PubMed]
  • Eriksson E, Brånemark PI. Osseointegration from the perspective of the plastic surgeon. Plast Reconstr Surg. 1994 Mar;93(3):626–637. [PubMed]

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