Abstract:Objective To explore the application value and prognostic differences between temporalis muscle flap transfer repair and nasal mucosal flap repair in the treatment of skull base necrosis and infection after re-irradiation for nasopharyngeal carcinoma, so as to provide a basis for clinical surgical selection. Methods A retrospective analysis was performed on the clinical data of 6 patients with radiation-induced skull base osteonecrosis after re-irradiation for nasopharyngeal carcinoma admitted to our center from November 2021 to February 2025. All patients underwent surgical treatment after ineffective conservative treatment, among which 2 cases were repaired with temporalis muscle flap transfer, and 4 cases with nasal mucosal flap repair (including 2 cases of pedicled nasal septal mucosal flap and 2 cases of free inferior turbinate mucosal flap). Baseline data, surgery-related information, postoperative efficacy and long-term follow-up data of the patients were collected. The symptom control effect, complication rate and long-term prognosis of the two surgical methods were compared, and the mechanism of efficacy difference was analyzed in combination with existing literature. Results Postoperative pain completely disappeared in all 2 patients with temporalis muscle flap repair, and no complications occurred. During the 3–41 months of postoperative follow-up, the skull base defects healed well without infection recurrence or flap necrosis. The necrosis range was reduced in all 4 patients with nasal mucosal flap repair, but complete healing was not achieved, and no severe surgery-related complications occurred. One patient died of refractory necrosis and internal carotid artery rupture and hemorrhage 3 years after the occurrence of necrosis, and the remaining 3 patients still had a small amount of local necrotic tissue during follow-up without new cranial nerve function injury. Conclusion Compared with nasal mucosal flap repair, temporalis muscle flap transfer repair has better pain control effect and short-term prognosis in the treatment of skull base necrosis and infection after re-irradiation for nasopharyngeal carcinoma, and can be used as the preferred surgical method for such patients. Nasal mucosal flap repair has limited efficacy and uncertain long-term prognosis, and can only be used as a supplementary scheme for patients who cannot tolerate temporalis muscle flap surgery. Strengthened long-term follow-up and monitoring are required after surgery.