Lateral orbital/anterior midfacial degloving approach for nasopharyngeal angiofibromas with cavernous sinus extension

Esthetically Favorable Surgical Alternative for the Removal of Sinonasal Malignant Tumors-The Modified Facial Degloving Technique

PURPOSE

The widely used external approach (Weber-Fergusson incision) for the removal of maxillary ethmoid tumors leaves stigmatizing scars and deformities on the patient's face. As an alternative technique, the scarless facial degloving approach was first described in the 1970s; since then, several modifications have been developed.

PATIENTS AND METHODS

The authors have been using a modified facial degloving technique for 7 years to remove maxillary ethmoid tumors. This article is a retrospective methodologic review. The inclusion criteria for this retrospective study were patients who underwent the modified facial degloving technique for management of malignant maxillary ethmoid tumors. The exclusion criteria were patients who did not undergo a surgical procedure (who received primary chemoradiation therapy) and patients who underwent an endoscopic surgical procedure for an early-stage localized tumor. The authors describe their method, which provides for a wide surgical approach using an osteoplastic flap for the entire nasal and paranasal region, with good cosmetic results. They present the adaptability of their method for 3 malignant maxillary ethmoid tumors in different locations.

RESULTS

From 2012 through 2016, 23 consecutive patients underwent surgery with the modified facial degloving approach at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Szeged (Szeged, Hungary). The authors evaluated their results with acoustic rhinometry and photographic documentation of postoperative facial expressions. Neither narrowing of the nasal cavity on the operated side (loss of nasal breathing function) nor facial movement dysfunction was visible in these patients.

CONCLUSION

Although several modifications of the original facial degloving approach have been published, in the present technique, the novel osteoplastic flap and the intact soft tissue of the nasal and midfacial region result in shorter hospitalization time and fewer complications. No functional or esthetic distortion was visible. No severe complications were observed; the patients' only complaint was the dryness of the nasal mucosa and temporary crusting of the nose. The present modified facial degloving technique offers proper and safe surgical resection for tumors of the maxillary ethmoid region. It can be routinely combined with endoscopic techniques and, if necessary, can be converted to an open approach.

A modified midfacial degloving approach for the treatment of unilateral paranasal sinus tumours

PURPOSE

The midfacial degloving approach (MFDA) is the primary option for the removal of benign and malignant sinonasal tumours. However, the classic MFDA does not compensate for the fact that most benign and malignant paranasal sinus (PNS) tumours are unilateral and the incisions may lead to some unnecessary complications?. Surgical exposure is limited to the upper and deep part of the PNS. Modifications of the classical MFDA that minimize complications and improve surgical field exposure are warranted.

PATIENTS

The medical records of 27 consecutive patients who had undergone surgery using a modified MFDA for treatment of unilateral benign or malignant tumours from 2000 to 2006, were reviewed.

RESULTS

We developed and performed a modified MFDA utilizing a hemigingivobuccal incision, a transfixion incision, mucosal detachment of the pyriform aperture and separation of the upper lateral cartilage from the nasal bone in 27 patients with unilateral benign (85%) or malignant (15%) PNS neoplasms. Adequate surgical exposure was achieved in all cases. No technical problems and no intraoperative complications related to the surgical procedure were encountered.

CONCLUSION

Our modified MFDA provides sufficient surgical exposure for the removal of unilateral malignant or benign PNS tumours with few surgical or cosmetic complications.

Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension

OBJECTIVES

To assess the efficacy and safety of endoscopic assisted antral window approach in advanced nasopharyngeal angiofibroma with infratemporal fossa extension.

MATERIALS AND METHODS

Sixteen cases diagnosed as juvenile nasopharyngeal angiofibroma type III with infratemporal fossa extension were surgically managed using endoscopic assisted antral window approach (group A) and compared with another group of similar number that were managed using endoscopic assisted midfacial degloving (group B). Inclusion criteria were type III JNA with infratemporal fossa extension and a minimum follow-up of 2 years. Operative time, blood loss, adverse events and recurrences were recorded in all cases.

RESULTS

The amount of blood lost in group A was significantly less than group B. The operative time of group A was significantly less than group B. No major complications were seen in both groups. Twenty-eight patients showed complete tumor clearance. Four recurrences were seen: two in group A and two in group B.

CONCLUSION

Endoscopic assisted antral window approach provides a safe, reliable, effective and minimally invasive technique in management of type III JNA with infratemporal fossa extension. Preoperative embolization is a safe measure in the experienced hands that helps to reduce intraoperative blood loss and improves the quality of the surgical field.

Temporal approach for resection of juvenile nasopharyngeal angiofibromas

OBJECTIVE

To describe a lateral preauricular temporal approach for resection of juvenile nasopharyngeal angiofibroma (JNA).

STUDY DESIGN

A retrospective review of five patients with JNA tumors that were resected by a lateral preauricular temporal approach.

METHODS

The medical records of five patients who underwent resection of JNA tumors via a lateral preauricular temporal approach were reviewed, and the following data collected: tumor extent, blood loss, hospital stay, and surgical complications.

RESULTS

Five patients with JNA tumors had resection by a lateral preauricular temporal approach. These tumors ranged from relatively limited disease to more extensive intracranial, extradural tumors. Using the staging system advocated by Andrews et al., these tumors included stages II, IIIa, and IIIb. Four patients (stages II, IIIa, IIIa, and IIIb) who underwent primary surgical excision had minimal blood losses and were discharged on the first or third postoperative day with minimal transient complications (mild trismus, frontal branch paresis, serous effusion, and cheek hypesthesia). The remaining patient (stage IIIb) did well after surgery, despite having undergone preoperative radiation therapy and sustaining a significant intraoperative blood loss. There have been no permanent complications or tumor recurrences.

CONCLUSIONS

A lateral preauricular temporal approach to the nasopharynx and infratemporal fossa provides effective exposure for resection of extradural JNA tumors. The advantages of this approach include a straightforward route to the site of origin, the absence of facial and palatal incisions, and avoidance of a permanent ipsilateral conductive hearing loss.