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Successful management of recurrent adenoid cystic carcinoma in the deep infratemporal fossa by maxillo-orbito-zygomatic approach. Auris Nasus Larynx 2019; 46:921-926. [DOI: 10.1016/j.anl.2018.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 11/23/2022]
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2
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Use of the facial dismasking flap approach for surgical treatment of a multifocal craniofacial abscess. Arch Plast Surg 2018; 45:271-274. [PMID: 29788681 PMCID: PMC5968315 DOI: 10.5999/aps.2017.00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/22/2017] [Accepted: 09/19/2017] [Indexed: 12/03/2022] Open
Abstract
The decision of which surgical approach to use for the treatment of a multifocal craniofacial abscess is still a controversial matter. A failure to control disease progress in the craniofacial region can potentially put the patient’s life at risk. Therefore, understanding the various ways to approach the craniofacial region helps surgeons to obtain satisfactory results in such cases. In this report, we describe a patient who visited the emergency department with a large swelling in his right cheek. A blood test and computed tomography revealed odontogenic maxillary sinusitis. The patient developed sepsis due to a progressive multifocal abscess. An abscess was seen in the temporal muscle, infratemporal fossa, and interorbital region. To control this multifocal abscess, we used the facial dismasking flap (FDF) approach. After debridement using the FDF approach, we succeeded in obtaining sufficient drainage of the abscess, and the patient recovered from sepsis. The advantages of the FDF approach are that it provides a wide surgical field, extending from the parietal region to the mid-facial region, and that it leaves no aesthetically displeasing scars on the face. The FDF approach may be one of the best options to approach multifocal abscesses in the craniofacial region.
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A Cadaver Study to Assess the Feasibility of a Cross-Nerve Transfer of the Infraorbital Nerve for Patients With Peripheral Infraorbital Nerve Injury. Ann Plast Surg 2018; 80:141-144. [DOI: 10.1097/sap.0000000000001188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Indication for and Limitation of the Facial Dismasking Flap Approach for Skull Base Surgery to Achieve the Best Esthetical and Functional Results. Ann Plast Surg 2016; 78:49-53. [PMID: 27956720 DOI: 10.1097/sap.0000000000000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The facial dismasking flap (FDF) approach to operations on the deep skull base region consists of a coronal incision and a circumpalpebral incision. This approach provides a wide surgical field for extirpation of deep extended craniofacial tumors without leaving any undesirable scars on the face. Therefore, the FDF approach can provide satisfactory esthetical and functional results. Meanwhile, in some cases, especially in patients with a history of skull base surgery or orbital extension, patients are not fully satisfied even when the FDF approach is used. In this study, we evaluated the indication for and limitation of the FDF approach. METHODS We reviewed 26 patients who underwent the FDF approach for skull base surgery. The patients were 16 men and 10 women, and average age was 37 years. Of these patients, 21 were treated using a hemi-FDF approach, and the remaining 5 were subjected to a bilateral FDF approach. Patients were divided into 2 groups in this study: group A (11 patients), patients with no history of skull base surgery and orbital extension; and group B (15 patients), patients with a history of skull base surgery and/or orbital extension. RESULTS There was no FDF loss or facial palsy in either group A or group B. In group A, there was no lagophthalmos or scar contracture of the eyelid. In group B, there were 5 cases (33%) of ectropion and lagophthalmos and 7 of eyelid scar contracture (46%). As for esthetical evaluation, group B showed a significantly higher rate of facial asymmetry than group A. Moreover, in group A, the total ratings for above average reached 90.9%, whereas in group B, nearly half of the patients (48.9%) gave ratings of fair and poor. CONCLUSIONS The FDF approach could be a good option for skull base surgery. In particular, patients without a history of skull base surgery and orbital extension could obtain satisfactory esthetical and functional outcomes. However, the procedure had limited effectiveness for patients with a history of skull base surgery or orbital extension because esthetical and functional outcomes inevitably became worse.
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Feasibility and Advantage of a Muscle-Sparing Laterally Based Pericranial Flap. J Craniofac Surg 2016; 27:552-7. [DOI: 10.1097/scs.0000000000002438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sakata K, Maeda A, Rikimaru H, Ono T, Koga N, Takeshige N, Tokutomi T, Umeno H, Kiyokawa K, Morioka M. Advantage of Extended Craniofacial Resection for Advanced Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Surgical Management. World Neurosurg 2016; 89:240-54. [PMID: 26875653 DOI: 10.1016/j.wneu.2016.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Craniofacial resection (CFR) for advanced sinonasal malignant tumors (SNMTs) is mandatory for radical resection. Surgeons must be aware of perioperative complications and long-term outcome because this procedure is extremely invasive, especially when the tumor involves the anterior skull base. METHODS Thirty-eight consecutive surgical patients with advanced SNMT of T4 stage or Kadish stage C (31 men and 7 women; mean age, 55 years; range: 19-76 years) treated with CFR in the past 28 years were followed up for 59.4 months. In cases of unilateral orbital extension, en-bloc resection was achieved using several neurosurgical techniques (extended CFR) from 2005 onwards. Herein, we evaluated the safety and effectiveness of surgery by comparing survival data between 2 time periods (first stage: 1984-2004, second stage: 2005-2012). RESULTS Squamous cell carcinoma was the most common histological type observed (65.8%), followed by esthesioneuroblastoma (15.8%). Using a combination of adjuvant radiation therapy, the 5-year overall survival and the 5-year disease-specific survival rates were 55.5% and 59.4%, respectively. Sarcomatous histology was a poor prognostic factor. The 5-year disease-specific survival rate was 48.9% in the first stage and improved to 82.1% in the second stage (P = 0.057); this was related to improvements in local control rate. CONCLUSIONS CFR and postoperative radiotherapy are safe and effective for treating advanced SNMTs. Extended CFR, including radical orbital exenteration, may contribute to good long-term outcomes. A diverse surgical team may help perform radical resection and reconstruction in patients with advanced tumors.
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Affiliation(s)
- Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
| | - Akiteru Maeda
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Noriyuki Koga
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Hirohito Umeno
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
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Use of Intraoperative Fluorescent Indocyanine Green Angiography for Real-Time Vascular Evaluation of Pericranial Flaps. Ann Plast Surg 2016; 76:198-204. [DOI: 10.1097/sap.0000000000000519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Masuda M, Fukushima J, Fujimura A, Uryu H. Combined transcervical and orbitozygomatic approach for the removal of a nasopharyngeal adenocarcinoma. Auris Nasus Larynx 2015; 43:192-6. [PMID: 26165630 DOI: 10.1016/j.anl.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/24/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In some cases, the exposure and safeguarding of the internal carotid artery (ICA) are not easy by the maxillary swing approach that is used as a mainstay for the removal of nasopharyngeal tumors. To address this issue, we have developed a new combined transcervical and orbitozygomatic approach. METHODS A nasopharyngeal adenocarcinoma arose in a 52-year-old patient and occupied the right middle skull base extending to the ICA. We first identified and dissected the ICA from the posterolateral part of the tumor using a transcervical approach. Then, the tumor was approached and removed by an orbitozygomatic technique with hemifacial dismasking. The surgical defect was filled using a temporal muscle flap, which was divided into two parts according to the blood supply from either the anterior or the posterior deep temporal artery. RESULTS The postoperative course was uneventful and favorable cosmetic results were obtained. The patient has been free of carcinoma for more than 40 months after the surgery. CONCLUSION Our new combined approach might be a good option for selected patients with nasopharyngeal tumors.
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Affiliation(s)
- Muneyuki Masuda
- Department of Head and Neck Surgery, National Kyushu Cancer Center, 3-1-1, Notame, Minamiku, Fukuoka 811-1395, Japan.
| | - Junichi Fukushima
- Department of Otorhinolaryngology and Head and Neck Surgery, Japanese Fukuoka Red Cross Hospital, 3-1-1, Okusu, Minamiku, Fukuoka 815-8555, Japan
| | - Akiko Fujimura
- Department of Otorhinolaryngology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
| | - Hideoki Uryu
- Department of Otorhinolaryngology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
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Nomura F, Kishimoto S. Synovial sarcoma of the temporomandibular joint and infratemporal fossa. Auris Nasus Larynx 2014; 41:572-5. [DOI: 10.1016/j.anl.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 07/05/2014] [Accepted: 07/15/2014] [Indexed: 11/27/2022]
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Yamada M, Tsunoda A, Tokumaru T, Aoyagi M, Kawano Y, Yano T, Kishimoto S. Surgery for juvenile nasopharyngeal angiofibroma with lateral extension to the infratemporal fossa. Auris Nasus Larynx 2014; 41:359-63. [PMID: 24685728 DOI: 10.1016/j.anl.2014.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 02/11/2014] [Accepted: 02/27/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The study aimed to assess the usefulness of skull base surgery for large juvenile nasopharyngeal angiofibroma (JNA) with lateral extension to the infratemporal fossa. MATERIALS AND METHODS Eleven cases were enrolled for this study, and the mean age was 17.7 years old (range: 8-32). Six out of 11 cases underwent surgery as an initial treatment, and the other five underwent secondary surgery after initial surgery or radiotherapy in other institutions. The range of extension of tumor, feeding arteries, surgical approach, and treatment outcome were estimated. RESULTS All tumors originated from the sphenopalatine foramen. Based on the imaging study, there was extension to the cavernous sinus observed in eight cases, as well as to the middle cranial fossa (8), orbit (4), and anterior cranial fossa (1). These tumors were diagnosed as Andrews' Stage IVa (3) and IVb (8). However, infiltration into the cavernous sinus was observed in one case only during surgery. Ten tumors were separated carefully from the cavernous sinus or dura and were accurately diagnosed as Stage IIIb. In all cases, the main arterial feeders of the JNAs were branches of the external carotid artery, which were embolized prior to surgery. However, 10 cases were also fed by branches of the internal carotid artery (branches of the ophthalmic artery), in which these arteries could not be embolized. Coronal skin incision (1) and a facial dismasking flap (9) were used, and in one case, wide lateral skin incision with temporary incision of the facial nerve was applied. The orbito-zygomatic approach and its modification was applied to all the cases. Fronto-lateral craniotomy was applied in four cases and lateral craniotomy in seven cases. Total resection was achieved in 10 cases and subtotal resection in one case. No mortality was noted in this series. Temporal trismus was observed in all cases which subsided gradually. Cheek numbness and facial palsy were observed in three and two cases, respectively. CONCLUSION Coupled with craniotomy, tumor removal was successfully carried out in 11 patients with JNAs, which showed large lateral extension. Our surgical strategy is a safe and effective approach for the removal of JNAs with infratemporal fossa extension.
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Affiliation(s)
- Masato Yamada
- Department of Otolaryngology, Tokyo Medical and Dental University, Japan
| | - Atsunobu Tsunoda
- Department of Otolaryngology, Tokyo Medical and Dental University, Japan.
| | - Takao Tokumaru
- Department of Otolaryngology, Tokyo Medical and Dental University, Japan
| | - Masaru Aoyagi
- Department of Neurosurgery, Tokyo Medical and Dental University, Japan
| | - Yoshihisa Kawano
- Department of Neurosurgery, Tokyo Medical and Dental University, Japan
| | - Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Japan
| | - Seiji Kishimoto
- Department of Head & Neck Surgery, Tokyo Medical and Dental University, Japan
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Hasan Z, Clark JR, Fowler A. A facial dismasking approach for resection of an infratemporal fossa sclerosing epithelioid fibrosarcoma. ANZ J Surg 2012; 81:947-8. [PMID: 22507435 DOI: 10.1111/j.1445-2197.2011.05913.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yano T, Tanaka K, Kishimoto S, Iida H, Okazaki M. Reliability of and indications for pericranial flaps in anterior skull base reconstruction. J Craniofac Surg 2011; 22:482-5. [PMID: 21403559 DOI: 10.1097/scs.0b013e318207b714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Owing to changes in the treatment of skull-base tumors, such as perioperative radiotherapy and advances in approaching the skull base, the use of pericranial flaps should be reconsidered. Therefore, we reviewed the reliability of and indications for pericranial flaps in 26 cases in terms of patient background, the effects of preoperative and postoperative treatment, and the pattern of blood circulation. Flaps were harvested as 25 anteriorly based and 4 laterally based. As a result, postoperative complications were observed in 4 patients. No other risk factors, except for heavy smoking, were observed relative to patient background. Sixteen patients had perioperative radiotherapy, and complication rate was significantly higher in patients with preoperative radiotherapy than patients without preoperative radiotherapy (P=0.014). However, no complications, such as cerebral spinal fluid leakage and intracranial infection, were observed in patients receiving postoperative radiotherapy. Laterally based pericranial flaps had a high complication rate (25%), but it was not significantly higher than anteriorly based flaps (P=0.467). Five anteriorly based flaps were harvested with less feeding vessels as usual because of applying dismasking flap approach, but it did not lead to increasing in complication rate. We conclude that a pericranial flap can be used for skull base reconstruction even if postoperative radiotherapy is planned but might be avoided for patients who have received preoperative radiotherapy. In addition, particular care and flap design should be taken to preserve sufficient vascularity when pericranial flaps are raised as laterally based and less feeding vessels as usual.
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Affiliation(s)
- Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
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Fujimoto T, Imai K, Takahashi M, Hatano T, Tamai M, Nakano T, Sakamoto H, Ohata K. Retrospective assessment of the dismasking flap procedure as a craniofacial approach. J Neurosurg Pediatr 2011; 7:345-50. [PMID: 21456904 DOI: 10.3171/2011.1.peds10271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In 1997 the authors presented the case of a 3-year-old girl who underwent complete resection of a huge tumor via a new technique using a dismasking flap. Since that report, 14 patients have undergone surgery using this technique. There have been few reports on long-term follow-up after a craniofacial surgical approach and reconstruction of a huge tissue defect. The authors report details of this procedure based on these cases, including long-term follow-up in the original case. METHODS The dismasking flap is a cranioorbitofacial degloving method that uses a circumpalpebral approach with or without piriform margin incisions and presents a wide surgical field under direct vision. Fourteen patients have undergone surgery using the dismasking flap technique. These patients had multiple craniofacial bone fractures (3 cases) and malignant or premalignant craniofacial tumors (11 cases). Patients ranged in age from 3 to 62 years old. The longest follow-up period was 15 years. The results of these cases are reported regarding changes in the facial bones and soft tissues with growth, the various pathologies involved, and complications. RESULTS Complications using this approach were lagophthalmos with ectropion of the lower eyelid, disturbance of the superior orbital nerve, disturbance of the inferior orbital nerve, maxillary hypoplasia, and blepharoptosis. In all affected patients these complications were almost always temporary. In 2 of the 14 cases, a repair operation for lagophthalmos was necessary, while others showed spontaneous improvement approximately 6 months to a year after the procedure. In the case with the longest follow-up duration, the patient's nose is asymmetrical, especially the alar portion, due to hypoplasia of the grafted bone and/or the fixation with titanium miniplates. CONCLUSIONS This flap is very useful for en bloc resection of huge skull base tumors, multiple craniofacial bone fractures, and as a lateral approach to a deep portion of the middle cranial base. Careful attention is necessary, however, because one may encounter unexpected complications if one does not ensure adequate protection of the perioperative flap. Meticulous postoperative management is also essential.
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Affiliation(s)
- Takuya Fujimoto
- Department of Plastic and Reconstructive Surgery, Osaka City General Hospital, Osaka, Japan
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Ohno K, Tsunoda A, Shirakura S, Takahashi N, Kishimoto S. The approaches and outcomes of skull base surgery for pediatric sarcoma after initial therapy. Auris Nasus Larynx 2010; 38:208-14. [PMID: 21055890 DOI: 10.1016/j.anl.2010.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 07/31/2010] [Accepted: 08/13/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Surgical removal of the residual pediatric sarcoma after initial therapy is common; however, that in the skull base area still presents a formidable challenge. We reviewed the approaches and outcomes of skull base surgery for pediatric sarcoma. METHODS Thirteen patients with pediatric sarcoma who received skull base surgery were reviewed retrospectively. Tumor sites, surgical approach, complications, regional recurrence after surgery, and survival rate were analyzed. RESULTS The residual tumor sites were the infratemporal fossa (8), nasal cavity and paranasal sinus (4) and orbit with anterior skull base invasion (1). Coronal skin incision (1), that with preauricular skin incision (7) and facial dismasking flap (5) were applied to patients as the skin preparation. Following skin preparations, anterior skull base surgery with frontal craniotomy (3), infratemporal fossa approach with temporal craniotomy (5), and anterior-lateral skull base with front-temporal craniotomy (1) were performed. Tumors were removed with a sufficient surgical field in all patients. Facial nerve palsy (9), facial deformity (4), orbital complications (diplopia, decreased visual acuity, narrowing of visual field) (2) and occlusal imbalance (1) occurred. However, facial palsy, diplopia and occlusal imbalance subsided gradually. Local recurrence occurred in 6 cases and distant metastasis was observed in 4 cases. The overall 5-years survival rate was 51.9% (Kaplan-Meier method). CONCLUSION These tumors were safely removed with minimum morbidity. Skull base surgery is recommended to remove residual pediatric sarcoma after the initial treatment.
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Affiliation(s)
- Kazuchika Ohno
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Nasal downward swing approach coupled with the facial dismasking flap. Auris Nasus Larynx 2009; 37:217-9. [PMID: 19713061 DOI: 10.1016/j.anl.2009.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 06/20/2009] [Accepted: 07/04/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE For the purpose of an en bloc resection with sufficient margins, a wide surgical field is necessary. We have reported on the application of a facial dismasking flap for removals of craniofacial lesions in order to provide a better surgical field with less morbidity. In this paper, we are introducing a new method, which is called the "nasal downward swing approach". METHODS This approach is a modification of the facial dismaking flap, which elevates the nasal bone along with the facial skin. RESULTS This approach offers an extremely wide surgical field on the facial front, especially the nasal cavity, while keeping scarring or facial paresis down to a bare minimum. CONCLUSION This approach helps to preserve the entire shape of the nasal bone in particular, therefore, a good surgical option for pediatric patients.
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