Endoscopic Insetting of Free Flaps in Skull Base Reconstruction

Abstract

In the era of endoscopic surgery, endoscopic flap inset is the future for anterior skull base reconstructions. The main goal in the reconstruction of anterior skull base following oncologic surgery is to seal the brain from the nasopharyngeal cavity to avoid potentially lethal intracranial infections. Free vascularized tissue transfers may provide a robust reconstruction.

We describe a case in which a secondary reconstruction was achieved by means of endoscopic flap inset. A transmaxillary approach was used through a mucosal incision inside the upper sulcus and an anterior and medial maxillectomy. The flaps were placed with the tip in the sphenoidal sinus. The flaps were inserted through the maxillary sinus, and the vessels were tunneled through the cheek to reach the facial vessels. The reconstruction was successful and the follow-up uneventful. A multidisciplinary approach is mandatory for innovative techniques in skull base surgery.