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 re construction after tumor resection. They were classified into four types ac cording to the resected region. In 11 cases of type I resection, the orbita l part of frontal bone and/or cribriform plate of ethmoid bone were resecte d. In two cases of type II resection, the orbital contents and partial orbi tal bone were resected with the addition of type I. In five cases of type I II 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 w ere resected with the addition of type III. The tumor originating from intr acranial 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 resect ed 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 recons truction. The rectus abdominis myocutaneous/muscle free flap was used for r econstruction of massive defects in type III and IV defects. Total incidenc e of postoperative complications was 16.7%. Donor site deformity of the cra nial flap at the frontal and temporal region in types I and II resections a nd 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 f lap combined with costal cartilages improved the midfacial contour, palpebr al reconstruction remained an unsolved problem in reconstructive skull base surgery. The reconstructive goals in skull base surgery are not only to ob tain safe and reliable skull base reconstruction but also to restore the fa cial appearance postoperatively.