Transfacial and Craniofacial Approaches for Resection of Sinonasal and Ventral Skull Base Malignancies

Perkins, Elizabeth; Brandon, Bryan M.; Sreenath, Satyan B.; Desai, Dipan D.; Thorp, Brian D.; Ebert, Charles S.; Zanation, Adam M.

doi:10.1016/j.otc.2016.12.006

Cited by 16 publications

(34 citation statements)

References 26 publications

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“…2 The transfacial approach begins with a classic lateral rhinotomy incision extended into a Weber-Ferguson when access to the palate or orbital floor is necessary. 1 The skin soft-tissue envelope is elevated off the nasal bones, medial and inferior orbital walls, and the anterior face of the maxilla. Care is taken to preserve the maxillary nerve and to carefully ligate the angular and ethmoid arteries.…”

Section: Transfacial Approachmentioning

confidence: 99%

“…The nasal dissection is then connected to intraoral bilateral sublabial incisions such that the entire skin soft-tissue envelope of the bilateral cheeks and nose can be lifted off the maxilla and nasal bones. 1 Following exposure of the maxilla, nasal bones, and orbit, either via midface degloving or a lateral rhinotomy with Weber-Ferguson, an osteotome can be directly applied to the nasal bones to allow their medial retraction with subsequent direct access to the nasal cavities and ethmoid sinuses. 1 Alternatively, LeFort I and midline split osteotomies can be performed for a "transmaxillary" approach to the clivus.…”

Section: Transfacial Approachmentioning

confidence: 99%

“…1 Following exposure of the maxilla, nasal bones, and orbit, either via midface degloving or a lateral rhinotomy with Weber-Ferguson, an osteotome can be directly applied to the nasal bones to allow their medial retraction with subsequent direct access to the nasal cavities and ethmoid sinuses. 1 Alternatively, LeFort I and midline split osteotomies can be performed for a "transmaxillary" approach to the clivus. 2 Similarly, orbitofrontal osteotomies could be performed for a transbasal approach to the suprasellar hypothalamus and tuberculum sellae tumors.…”

Section: Transfacial Approachmentioning

confidence: 99%

“…2 Finally, either transfacial approach could also be combined with a bicoronal approach to facilitate even greater bony exposure and allow a more extensive craniofacial resection. 1 The major drawbacks of transfacial approaches revolve around poor aesthetic outcomes from extensive facial incisions and distortion of the appearance of the nose (from osteotomies and disruption of the major tip support mechanisms. Further if the midface soft tissues are not appropriately resuspended, then patients can experience midface droop.…”

Section: Transfacial Approachmentioning

confidence: 99%

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Orbitocranial Approaches to the Skull Base

Vincent

Wang

Sokoya

et al. 2019

Seminars in Plastic Surgery

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There are a myriad of approaches and surgical options for removal and treatment of skull base diseases. While, historically, large open approaches have been preferred, several endoscopic and minimally invasive techniques are now available that preserve intraoperative visualization and surgical success while minimizing morbidity and recovery times. Herein, the authors review common open, minimally invasive, and endoscopic approaches to the anterior skull base.

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Section: Transfacial Approachmentioning

confidence: 99%

Section: Transfacial Approachmentioning

confidence: 99%

Section: Transfacial Approachmentioning

confidence: 99%

Section: Transfacial Approachmentioning

confidence: 99%

See 2 more Smart Citations

Orbitocranial Approaches to the Skull Base

Vincent

Wang

Sokoya

et al. 2019

Seminars in Plastic Surgery

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“…Second, if the frontal skull base is sloped and not flattened, it may cause the flap to pull away from the anterior defect. 6,[15][16][17] …”

Section: Surgical Stepsmentioning

confidence: 99%

Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

Chakravarthi

Gonen

Monroy-Sosa

et al. 2017

Seminars in Plastic Surgery

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Endoscopic approaches and techniques to the anterior skull base, sellar, and parasellar regions have contributed significantly to the field of skull base surgery, facilitating the resection of complex skull base lesions with a minimal surgical footprint. The most clinically significant complication with these approaches has been the incidence of postoperative cerebrospinal fluid (CSF) leak. 1 Once the initial feasibility and efficacy were established, demonstrating improved neurological outcomes, reconstruction, CSF leaks became the primary challenge. The expanded endoscopic endonasal approach (EEA) followed the same progression as open skull base surgery such that reconstruction from grafts to vascularized flaps allowed a concomitant reduction in CSF leak rates, which are now in the range of 1 to 5%. [2][3][4] The EEAs have been organized into the following corridors along the coronal and sagittal planes, which span the entire ventral anterior, middle, and posterior cranial fossa, providing access via a series of modular approaches; specifically, the transfrontal, transcribriform, transplanum-transtuberculum, transsellar, transclival, transodontoid, and respective coronal modules. 5 The reconstruction is primarily dependent on the anatomic region and module undertaken relative to the availability of local and regional vascularized pedicled flaps. Several attempts at categorizing reconstruction options have been described, the most notable is by Patel et al. 6 There exists significant literature on the use of grafts, and as stated, as the EEA approaches evolved, so has the reconstruction from grafts to flaps. To avoid reiteration, in this article, we outline a pragmatic algorithmic approach focused exclusively on vascularized flap reconstruction; explicitly, we share with the readers our specific reconstruction algorithm that we have been using over the past decade to AbstractThe success of expanded endoscopic endonasal approaches (EEAs) to the anterior skull base, sellar, and parasellar regions has been greatly aided by the advancement in reconstructive techniques. In particular, the pedicled vascularized flaps have been developed and effectively cover skull base defects of varying sizes with a significant reduction in postoperative CSF leaks. There are two aims to this review: (1) We will provide our current, simplified reconstruction algorithm. (2) We will describe, in detail, the relevant anatomy, indications/contraindications, and surgical technique, with a particular emphasis on the nasoseptal flap (NSF). The inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF) will also be described. The NSF should be the primary option for reconstruction of majority of skull base defects following endonasal endoscopic surgery. In general, for the planum, cribriform, and upper two-thirds of the clivus, the NSF is ideal. For the lower-third of the clivus, the NSF may not be adequate and may require additional reconstructive options. Although limited in...

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The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

et al. 2020

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The aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous-site tumors. Methods: Descriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004-2016). Results: Of 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5-year OS: 53.4% [SE: 2.5%]) compared with cartilage tumors (5-year OS: 84.6% [SE: 1.8%]) (log-rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio [HR] 0.495 [95% CI: 0.366-0.670]). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 [0.697-2.438]). Conclusion: Treatment that included surgery was associated with an increased OS within our cohort of HN osseous-site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.

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Transfacial and Craniofacial Approaches for Resection of Sinonasal and Ventral Skull Base Malignancies

Cited by 16 publications

References 26 publications

Orbitocranial Approaches to the Skull Base

Orbitocranial Approaches to the Skull Base

Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

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