鼻咽癌再程放疗后颅底放射性骨坏死的手术清创与组织瓣修复OA

Objective To explore the application value and prognostic differences of temporalis muscle flap transfer repair and nasal mucosal flap repair in the treatment of skull base osteoradionecrosis after reirradiation for nasopharyngeal carcinoma,so as to provide a reference for the selection of surgical methods in clinical practice.Methods A retrospective analysis was performed on the clinical data of 6 patients with skull base osteoradionecrosis after reirradiation for nasopharyngeal carcinoma admitted to our center from November 2021 to May 2025.All the patients underwent surgical treatment after ineffective conservative treatment,among which 2 cases were treated with temporalis muscle flap transfer repair,and 4 cases with nasal mucosal flap repair(including 2 cases of pedicled nasal septal mucosal flap and 2 cases of free inferior turbinate mucosal flap).Baseline data,surgery-related information,postoperative efficacy and long-term follow-up data of the patients were collected.The symptom control effect,complication rate and long-term prognosis of the two surgical methods were compared,and the mechanism of efficacy difference was analyzed in combination with existing literature.Results The postoperative pain completely disappeared in the 2 patients treated with temporalis muscle flap repair.During the 6 to 18 months of postoperative follow-up,the skull base defects healed well without infection recurrence or flap necrosis.The necrotic area was reduced in all the 4 patients treated with nasal mucosal flap repair,but complete healing was not achieved,and no severe surgery-related complications occurred.One patient died of internal carotid artery rupture and hemorrhage 3 years after the onset of necrosis due to persistent non-healing necrosis.The remaining 3 patients still had a small amount of residual necrotic tissue.Conclusions Compared with nasal mucosal flap repair,temporalis muscle flap transfer repair has a more significant pain control effect and better short-term prognosis in the treatment of skull base osteoradionecrosis with infection after reirradiation for nasopharyngeal carcinoma,and can be used as the preferred surgical method for such patients.Nasal mucosal flap repair has limited efficacy and uncertain long-term prognosis,and can serve as a supplementary scheme for patients who cannot tolerate temporalis muscle flap surgery.Postoperative long-term follow-up and monitoring should be strengthened.