{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T16:43:19Z","timestamp":1786293799622,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healing dynamics after anterior skull base (ASB) reconstruction following transnasal endoscopic surgery (TES) for sinonasal malignancies remain poorly characterized. This study aimed to describe the postoperative healing process, quantify time to healing, identify factors influencing healing, and assess radiologic evolution over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective study included adult patients undergoing TES with craniectomy and ASB reconstruction for sinonasal malignancies between 2016 and 2024. Serial endoscopic examinations were reviewed using a novel stage\u2010based classification system. Postoperative contrast\u2010enhanced magnetic resonance imaging (MRI) was analyzed to evaluate reconstruction layers, enhancement patterns, thickness changes, and brain sagging. Cumulative incidence analysis, multistate modeling, and uni\u2010 and multivariable analyses were performed to identify factors associated with healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 173 patients were included. Complete endoscopic healing was achieved in 15.9% of patients at 6 months, 69.9% at 12 months, and 94.4% at 24 months. Local pedicled flap reconstruction was associated with faster healing, with complete healing achieved in 89.4% of patients at 12 months compared with 60.7% in graft\u2010based reconstructions (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Adjuvant radiotherapy (RT), particularly intensity\u2010modulated proton therapy, was independently associated with delayed healing. MRI showed progressive reduction in reconstruction thickness, decreased visibility of adipose tissue and the outer graft layer, and increased brain sagging over time. RT was associated with greater remodeling changes, whereas flap\u2010based reconstruction appeared to mitigate these effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Healing after ASB reconstruction following TES is a prolonged and dynamic process influenced mainly by reconstruction technique and adjuvant RT. Local vascularized flaps promote faster and more stable healing and may be particularly advantageous in patients requiring postoperative RT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.70232","type":"journal-article","created":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T16:27:44Z","timestamp":1786292864000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Healing Following Endoscopic Reconstruction of the Anterior Skull Base in Patients With Sinonasal Malignancies"],"prefix":"10.1002","author":[{"given":"Giacomo","family":"Contro","sequence":"first","affiliation":[{"name":"Section of Otorhinolaryngology\u2010Head and Neck Surgery Department of Neuroscience (DNS) University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Calvanese","sequence":"additional","affiliation":[{"name":"ENT Unit Surgical Department Ospedali Riuniti Padova Sud  Monselice\u2010Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio","family":"Gaudioso","sequence":"additional","affiliation":[{"name":"Section of Otorhinolaryngology\u2010Head and Neck Surgery Department of Neuroscience (DNS) University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Taboni","sequence":"additional","affiliation":[{"name":"Section of Otorhinolaryngology\u2010Head and Neck Surgery Department of Neuroscience (DNS) University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mos\u00e8","family":"Sozzi","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, S. Valentino Hospital, Montebelluna (TV)  AULSS2 Marca Trevigiana Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Schiavo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery ASST Lariana, Ospedale Sant'Anna University of Insubria  Como Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Sordi","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology, ASST del Garda Manerbio Hospital  Manerbio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Dohin","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology\u2013Head and Neck Surgery ASST Spedali Civili di Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mularoni","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery Department of Surgery The 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