Single-Stage Rigid Midfacial Reconstruction Using Split Calvarial Bone after Anterior Skull Base Surgery: A Case Report.

Reports of frontal and nasal bone-involving composite midfacial bone defect reconstruction after anterior skull base tumor resection remain scarce. Here, we present the case of a 75-year-old man with recurrent ethmoid sinus carcinoma who underwent combined transcranial and endonasal endoscopic resection. The resulting defects included the anterior skull base and frontal and nasal bones. A pericranial flap was used for skull base closure, achieving rigid midfacial reconstruction in a single stage using the split outer and inner cranial bone tables harvested during craniotomy. Titanium plates were used for fixation. The medial canthal ligaments were reattached with intracranially placed sutures and embedded within the pericranial flap to reduce the risk of infection. One month postoperatively, the esthetic result was favorable, with no midfacial depression. Although the patient died from disease recurrence three months postoperatively, this method potentially offers a practical and cosmetically effective option for anterior skull base reconstruction.