Anterior skull base(ASB)defects present a significant challenge in head and neck reconstructive surgery.The main goal of skull base reconstruction is to create a watertight separation between the intracranial cavity a...Anterior skull base(ASB)defects present a significant challenge in head and neck reconstructive surgery.The main goal of skull base reconstruction is to create a watertight separation between the intracranial cavity and aerodigestive tract.Successful reconstruction aims to prevent cerebrospinal fluid(CSF)leak,pneumocephalus,and a range of infectious manifestations.Functional outcomes and cosmesis are also critical considerations when developing a reconstructive plan.Advancements with endoscopic endonasal approaches have revolutionized skull base surgery but also have created new reconstructive challenges due to the narrow operative corridor,especially for extensive defects or salvage cases where microvascular free tissue transfer is required.Though a variety of techniques including local,regional,and free flaps have been described,ASB reconstruction remains a difficult undertaking due to the complex anatomy and high risk for post-operative complications.This review provides a comprehensive discussion of available reconstructive techniques that can be used after both open and endoscopic ASB resections to help determine the optimal reconstruction for a variety of defects.展开更多
Medical modeling and 3-dimensional(3D)virtual surgical planning represent a rapidly expanding,technological advancement especially useful in complex mandibular or maxillary defects in head and neck reconstruction.With...Medical modeling and 3-dimensional(3D)virtual surgical planning represent a rapidly expanding,technological advancement especially useful in complex mandibular or maxillary defects in head and neck reconstruction.With utilization of 3D surgical planning,the reconstructive surgeon can initiate dental rehabilitation during the primary surgery with osseointegrated implants(OI),streamlining a typically lengthy process to full oral rehabilitation.Careful patient selection is important to optimize outcomes with immediate OI,and factors to consider during the evaluation process include pathology,prognosis,anticipated defect,dental status,donor site availability,and patient motivation and resources.Synthesizing this information and developing a reconstructive plan with a multidisciplinary team approach is critical to expedite dental rehabilitation for select patients.A review of relevant literature and our surgical planning algorithm for selecting candidates for immediate OI is provided,along with our experience using this decision algorithm in a uniquely complex clinical case.展开更多
文摘Anterior skull base(ASB)defects present a significant challenge in head and neck reconstructive surgery.The main goal of skull base reconstruction is to create a watertight separation between the intracranial cavity and aerodigestive tract.Successful reconstruction aims to prevent cerebrospinal fluid(CSF)leak,pneumocephalus,and a range of infectious manifestations.Functional outcomes and cosmesis are also critical considerations when developing a reconstructive plan.Advancements with endoscopic endonasal approaches have revolutionized skull base surgery but also have created new reconstructive challenges due to the narrow operative corridor,especially for extensive defects or salvage cases where microvascular free tissue transfer is required.Though a variety of techniques including local,regional,and free flaps have been described,ASB reconstruction remains a difficult undertaking due to the complex anatomy and high risk for post-operative complications.This review provides a comprehensive discussion of available reconstructive techniques that can be used after both open and endoscopic ASB resections to help determine the optimal reconstruction for a variety of defects.
文摘Medical modeling and 3-dimensional(3D)virtual surgical planning represent a rapidly expanding,technological advancement especially useful in complex mandibular or maxillary defects in head and neck reconstruction.With utilization of 3D surgical planning,the reconstructive surgeon can initiate dental rehabilitation during the primary surgery with osseointegrated implants(OI),streamlining a typically lengthy process to full oral rehabilitation.Careful patient selection is important to optimize outcomes with immediate OI,and factors to consider during the evaluation process include pathology,prognosis,anticipated defect,dental status,donor site availability,and patient motivation and resources.Synthesizing this information and developing a reconstructive plan with a multidisciplinary team approach is critical to expedite dental rehabilitation for select patients.A review of relevant literature and our surgical planning algorithm for selecting candidates for immediate OI is provided,along with our experience using this decision algorithm in a uniquely complex clinical case.
