{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T18:17:46Z","timestamp":1793989066969,"version":"4.8.0"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T00:00:00Z","timestamp":1659484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Osteoradionecrosis (ORN) of the skull base and craniovertebral junction is a challenging complication of radiation therapy (RT). Severe cases often require surgical intervention through a multi\u2010modal approach. With the evolution in endoscopic surgery and advances in skull base reconstruction, there is an increasing role for microvascular free tissue transfer (MFTT). We describe an endoscopic\u2010assisted approach for the management of ORN of the skull base using fascia lata for MFTT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective case series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 2017 and 2021, a review of all cases in which fascia lata MFTT was utilized for skull base ORN was performed. Patient demographics, preoperative characteristics, and postoperative outcomes with long\u2010term follow\u2010up were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five patients were identified. Mean duration to onset of ORN was 17\u2009months following RT. A trial of antibiotics, hyperbaric oxygen (HBO), and\/or limited debridement was attempted without success. Refractory pain and progressive osteomyelitis were unifying symptoms. All patients underwent endoscopic debridement of the affected region of ORN prior to MFTT. Vascularized fascia lata was inset through a combined endonasal and transoral corridor. There was improvement in chronic pain in the postop setting with no patients requiring continued antibiotics or HBO therapy. Mean post\u2010op follow\u2010up was 23\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>With continued evolution in endoscopic, minimally invasive approaches, there is an expanding indication for early surgical management in refractory ORN. Fascia lata MFTT is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 133:562\u2013568, 2023<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30315","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T08:42:58Z","timestamp":1659516178000},"page":"562-568","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0384-9870","authenticated-orcid":false,"given":"Satyan B.","family":"Sreenath","sequence":"first","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic  Cleveland Ohio U.S.A."},{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Indiana University  Indianapolis Indiana U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Grafmiller","sequence":"additional","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2315-9930","authenticated-orcid":false,"given":"Dennis M.","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Cedars\u2010Sinai Medical Center  Los Angeles California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Roof","sequence":"additional","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic  Cleveland Ohio U.S.A."},{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Icahn School of Medicine at Mt. 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Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic  Cleveland Ohio U.S.A."},{"name":"Department of Neurological Surgery Cleveland Clinic Lerner College of Medicine of Case Western Reserve University  Cleveland Ohio U.S.A."},{"name":"Minimally Invasive Cranial Base and Pituitary Surgery Program Rose Ella Burkhardt Brain Tumor and Neuro\u2010Oncology Center, Neurological Institute, Cleveland Clinic  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9748-2784","authenticated-orcid":false,"given":"Pablo F.","family":"Recinos","sequence":"additional","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic  Cleveland Ohio U.S.A."},{"name":"Department of Neurological Surgery Cleveland Clinic Lerner College of Medicine of Case Western Reserve University  Cleveland Ohio 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