Vastus Lateralis Muscle Free Flap for Skull Base Osteoradionecrosis in Nasopharyngeal Carcinoma

Alexander C. Vlantis; Eddy W.Y. Wong; Tor W. Chiu; Jason Y.K. Chan

doi:10.1055/s-0037-1608714

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2018; 79(04): 349-352
DOI: 10.1055/s-0037-1608714

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Vastus Lateralis Muscle Free Flap for Skull Base Osteoradionecrosis in Nasopharyngeal Carcinoma

Alexander C. Vlantis

¹Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

,

Eddy W.Y. Wong

¹Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

,

Tor W. Chiu

²Division of Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

,

Jason Y.K. Chan

¹Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

› Author Affiliations

Abstract

Objectives To describe the first experience with a free vastus lateralis muscle-only flap to be used to cover and protect the exposed skull base and carotid artery from radiotherapy-induced skull base osteoradionecrosis (ORN).

Design Retrospective review of a case series.

Setting Tertiary academic medical center.

Participants Post treatment nasopharyngeal carcinoma patients with skull base ORN.

Main Outcome Measures Coverage of the internal carotid artery (ICA).

Results Four patients underwent the procedure. Following the procedure, all patients were documented to have adequate viable soft tissue covering their ICA. Topical nasal steroids were prescribed to all patients as florid granulation tissue was noted to occur overlying the muscle flap in the early postoperative period. There were no flap failures. All patients noted an improvement in speech, cacosmia, and nasal crusting. No significant epistaxis occurred following surgery. Choanal stenosis was noted in three patients.

Conclusion For skull base ORN resulting from the treatment of nasopharyngeal carcinoma (NPC) with radiotherapy that fails conservative management, an open approach to the nasopharynx, that allows debridement then placement of a vastus lateralis muscle-only free flap for coverage, offers a unique and viable approach to the management of this challenging condition.

Keywords

skull base - nasopharyngeal carcinoma - osteoradionecrosis - vastus lateralis - free flap

Full Text

References

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