Comprehensive management of temporal bone defects after oncologic resection

Objectives/Hypothesis: To evaluate reconstructive outcomes following oncologic temporal bone resection. Study Design: Retrospective review. Methods: Subjects consisted of 117 patients undergoing temporal bone resection and reconstruction between 2000 and 2010. Reconstructive outcomes, including results following facial nerve repair, were analyzed. Results: Reconstruction was performed with a regional flap in 27 patients and a microvascular free flap in 90 patients. Operative time was shorter for cases involving reconstruction with regional flaps compared to free flaps (6.9 vs. 11.2 hours, P <.0001), as were intensive care unit and hospital stays (0.4 vs. 3.4 days, P <.0001 and 4.1 vs. 8.6 days, P <.0001, respectively). Overall complication rates were similar for regional and free flap cases (22.2% vs. 23.3%, P = 1.00), although donor site complications were more common with free flaps (0% vs. 13.3%, P =.07). Facial nerve repairs were performed in 19 patients. Of 14 patients with more than 12 months of follow-up, 71.4% demonstrated signs of reinnervation and 42.9% achieved a House-Brackmann score of 3 or better. The mean time to reinnervation was 7.9 months. Recovery was not significantly affected by preoperative nerve function, postoperative radiation, or advanced age (P = 1.00 in each case). Conclusions: We recommend regional flaps for small defects based on minimal donor site morbidity, and shorter operative times, intensive care unit, and hospital stays. For extensive defects and in cases involving prior surgery or radiation, free flaps are preferred. Facial nerve repair should be attempted whenever feasible, even in the setting of preoperative weakness, planned postoperative radiation, and advanced age.