Reconstruction and Facial Reanimation After Temporal Bone Resection: A Multi‐Institution Experience

BACKGROUND: Temporal bone resection (TBR) may result in large defects and facial nerve sacrifice. METHODS: Retrospective review of adults undergoing TBR from 2008 to 2019. RESULTS: One hundred and forty patients were reviewed. The extent of TBR was lateral (n = 135), subtotal (n = 2), and total (n = 3). Defects were reconstructed with free flaps (n = 72), regional flaps (n = 45), and cervicofacial flaps (n = 31). Complications included wound dehiscence (n = 20), infection (n = 15), hematoma (n = 6), cerebrospinal fluid leak (n = 2), and meningitis (n = 1). Smoking history was associated with wound complications (OR = 1.23, p = 0.03). Prior resection (OR = 2.34, p = 0.03) and advanced T stage (OR = 1.38, p = 0.04) were associated with free flap reconstruction. Forty-seven patients underwent facial nerve sacrifice. Facial reanimation techniques included primary neurorrhaphy (n = 2), interposition nerve grafting (n = 28), masseteric (n = 7), or hypoglossal (n = 5) to nerve transfers, temporalis tendon transfer (n = 21), ectropion repair (n = 31), brow lift (n = 21), and upper eyelid loading (n = 40). CONCLUSION: Advanced T stage and re-resection are associated with free flap reconstruction after TBR.