Novel Approach to Osteoradionecrosis of the Temporal Bone: Vascularized Obliteration with Gracilis Muscular Free Flap

Osteoradionecrosis of the temporal bone (ORN-TB) is usually controlled with conservative measures. However, a temporal bone resection may be required in unresponsive cases. The reconstruction of the resulting defects may be challenging because of the radiation damage to regional tissues. As a result, distant free flaps may be an optimal choice. For instance, the gracilis muscular free flap (GMFF) has consistent vascular anatomy and can be used to reconstruct small defects. We report three cases of uncontrolled ORN-TB requiring an extensive temporal bone resection followed by vascularized obliteration with a GMFF. The patients reported complete control of the main otologic symptoms (otorrhea, otalgia, and aural fullness) and optimal functional and aesthetic outcomes. Finally, the patients reported significant improvement in quality of life despite early postoperative complications. To our knowledge, the GMFF had not been used to obliterate temporal bone defects in patients with ORN-TB.