Reconstruction of Large Fronto-Orbital Defects following Tumor Resection

Introduction: Larger defects of the skull or the skull base following tumor resection require microsurgical tissue transfer in order to seal the liquor compartment. The interdisciplinary approach and the results of a series of 12 patients will be presented here.

Material and Methods: Most cases (7) concerned the fronto-orbital region due to resection of adenoid-cystic or squamous cell carcinomas, an ameloblastoma, and a malignant meningioma. In 4 patients, larger skull defects had to be reconstructed and 2 defects comprised the rhinobasal area. Reconstruction was performed with latissimus dorsi, osteomyocutaneus scapula, radial forearm, and parascapular flaps.

Results: In 3 cases, revision was necessary which was successful in 2 cases. One reconstruction in the case of a glioblastoma multiform failed, and in another case with simultaneous implantation of a CAD/CAM reconstruction a late infection was observed. The others healed uneventfully. All but 1 patients were alive with a median follow-up of 2.5 years. In the case of fronto-orbital reconstruction, the osteomyocutaneous capular flap allowed the insertion of implants for epithetic rehabilitation of the orbital defect with good esthetic results.

Conclusions: Microsurgical tissue transfer provides the sealing of large defects of the skull or the skull base, also in the case of aggressive postoperative radiotherapy. Depending on the location of the defect, the different types of flaps are indicated. Osteomyocutaneous scapula provides an excellent osseous base for epithetic rehabilitation of the orbit in fronto-orbital defects.