The Transfacial Approach for Combined Anterior Craniofacial Tumor Ablation

Abstract

\s=b\The transfacial approach to the anterior cranial fossa for tumor removal provides for excellent surgical exposure, improved postoperative appearance, and a minimum of complications. The technique is different from previously reported combined craniofacial ablative procedures in that the head and neck surgeon and the neurosurgeon approach the anterior fossa mass through the same facial incision, thus avoiding the need for a separate craniotomy incision. The formation of a vascularized nasofrontal bone flap allows for better wound healing regardless of preoperative and postoperative radiotherapy and/or chemotherapy. This report presents 42 cases in which the transfacial approach was exclusively used in a combined manner to remove nasal, paranasal sinus, and nasopharyngeal neoplasms. The transfacial technique offers a significant advantage over previously described approaches to the anterior skull base. (Arch Otolaryngol Head Neck Surg 1989;115:301-307) Crani ofaci al surgery for tumor resection was introduced in 1941, when Walter E. Dandy,1 a neurosurgeon, published his text on neuro¬ surgical operative techniques that were used to resect orbital tumors. Dandy1 advocated the concept of extending the resection of orbital tumors into the central nervous sys¬ tem where they most frequently failed. This concept was furthered at first by Ray and McLean2 and later by Tym3 to improve the operative cure rate with retinoblastomas.

Nasal and paranasal sinus carcinoma: Are we making progress?

“…Several articles on patients who underwent craniofacial resection reported results as good as ours, but the results could not be included in the metaanalysis either because of large numbers of tumors with noncarcinoma histologies or because of a short followup. 8,9,46,[197][198][199] Nevertheless, several reports related outcomes better than ours for patients with squamous cell carcinoma, 48,56,106,100,110,117,132,137,147,160,168,176 for patients with glandular carcinoma, 160,168,184 and for patients with adenocarcinoma. 136,146 The systematic review revealed a steady improvement in treatment results for patients with squamous cell carcinoma and glandular carcinoma (Fig.…”

Craniofacial resection for malignant neoplasms of the skull base: An overview

“…Single frontal burr hole [29,30] Bifrontal craniotomy with multiple burr holes [16] Parasagittal burr holes and Midas Rex saw [53] Anterior subcranial approach [24,63] Facial disassembly approach [25,27] Frontal sinusotomy approach [64] Nasofrontal swing approach [23] [18,19] and Dias et al [51], operative mortality has been consistently reported to be under 5% (Tables VI, VII) [13,14,24,42,48,49]. A total of 37 postoperative deaths were identified in this review, and meningitis was the most common cause (Table VIII).…”

“…Today, skull base surgery teams depend on head and neck surgeons, neurosurgeons, microvascular plastic surgeons, maxillofacial prosthodontists, interventional and neuroradiologists, radiation oncologists, neuroanesthesiologists, intensivists, and rehabilitation specialists to successfully remove skull base malignancies and then reconstruct and rehabilitate patients. These cooperative efforts have improved survival, morbidity, and mortality of skull base surgery [12][13][14][15][16][17][18][19][20][22][23][24].…”

Transfacial nasal approach to paranasal sinuses, nasopharynx and anterior skull base

“…Operative microscope can be used if necessary. Tumor extension into the anterior cranial fossa can be removed as described by Panje et al [2] by additional incisions along the eyebrows from the glabellar incision and elevation of nasofrontal fl ap as in osteoplastic frontal sinus surgery and drilling the posterior frontal sinus. After en bloc tumor resection of tumor, the nasal fl ap is repositioned in its original postion.…”

“…Dandy [2] introduced craniofacial surgery in 1941 for orbital tumors. It was popularized by Ketcham et al [10] who made it an accepted option for nasal sinus apex tumors.…”