Nasopharyngeal angiofibroma. surgical approach using a transoral Le Fort I osteotomy following embolization: a case report

Le Fort I Down-Fracture for Management of Midface Tumors

OBJECTIVE

To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base.

METHODS

A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study.

RESULTS

Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients.

CONCLUSION

The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.

Emergency removal of a grinding wheel embedded in the midface via modified Le Fort I osteotomy

Le Fort I osteotomy is commonly used to rectify craniofacial deformity in orthognathic surgery and it can be used in approaching a cranial base lesion. This technique has not been well documented in craniofacial penetrating trauma. This article describes a case of midface penetrating injury caused by a grinding wheel. A modified Le Fort I osteotomy was used to remove the foreign object. This surgical approach can be safe and effective when removing foreign bodies in the midface. Good access and adequate exposure can be achieved, which facilitate precise foreign body extraction and achieve reasonable cosmetic results.

Juvenile nasopharyngeal angiofibroma: current treatment modalities and future considerations

Juvenile angiofibroma (JNA) is a relatively uncommon, highly vascular and benign tumor that presents most commonly in adolescent males. Symptoms may persist from months to years and often times, these tumors are asymptomatic until they increase and encroach on critical structures. Because of technological advances both in surgery and radiology, management of JNA patients has been refined. With the advent of more sophisticated capabilities such as CT, MRI, intensity-modulated radiation therapy (IMRT), stereotactic guidance systems as well as advanced embolization techniques, these tumors can be diagnosed and managed more effectively.Patients with juvenile angiofibroma (JNA) are typically silent for years and often present with epistaxis, nasal obstruction, facial numbness, rhinorrhea, ear popping, sinusitis, cheek swelling, visual changes and headaches. In addition to these symptoms, up to one-third of patients with this condition may present with proptosis or other orbital involvement, which are late symptoms and findings.Most physicians agree that surgery is the primary treatment modality for the early-stage disease process. However, controversy arises regarding the best treatment when a patient presents with more locally advanced disease involving widespread cranial-based extension or intracranial involvement which may necessitate a combination of treatment modalities including surgery and postoperative radiation.With the advancement of endoscopic surgery, there have been a number of cases reporting the value of its use. The purpose of this review, however, will address not only endoscopic alternatives, but will discuss other treatment options as reported in the literature. Robotic surgery of the skull base for JNA is something to expect for the future.Finally, with the advent of IMRT and an image-guided robotic radiotherapy delivery system, some researchers speculate that this will result in less objections for radiation in general and certainly less reservations for the use radiotherapy in certain circumstances, i.e. patient refusal of surgery or extensive non-resectable or recurrent JNA tumors.