Reconstruction of the Skull Base Using Temporalis Fascia after Endoscopic Resection of Advanced Nasal Sinus Cancer: A Step-by-step Video

Abstract Surgical resection of rhinopharyngeal and anterior skull base tumors is complex, and the endoscopic endonasal approach is preferred when feasible. The risk of carotid exposure, dura mater exposure, and osteoradionecrosis necessitates covering these structures. Local flaps may not always be feasible in certain situations (prior surgeries, tumor extensions). In such cases, reconstruction using a pedicled temporalis fascia flap can be considered. The aim of this article is to elucidate, through a video, the surgical procedure. This involves a video accompanied by anatomical drawings of a 37-year-old patient with a right-sided recurrent adenoid cystic carcinoma of the rhinopharynx treated with a right-sided type III rhinopharyngectomy with sphenoid base milling. The video explicates the key aspects of this surgery, including patient positioning, flap harvesting, flap passage, and placement in the resection area. The pedicled temporalis fascia flap represents a reliable alternative for reconstructions of the rhinopharynx and skull base when local flaps are no longer viable.