A transfacial approach, mid-face degloving and craniofacial resections for malignancies of the paranasal sinuses and anterior skull base

Malignancies of the nose, paranasal sinuses and anterior skull base are characterized by their hidden locations and late clinical manifestation. This explains why most of the patients at the University of Tubingen were diagnosed in an advanced tumor stage (15 T1/T2; 33 T3/T4). Surgical treatment was possible in 35 cases and depended on tumor location and extent. A lateral rhinotomy for a transfacial approach was performed in 8 tumors of the middle level and 6 tumors of the upper level as described by Sebileau. An advantage of this procedure was the exposure provided with a working direction parallel to skull base and orbit allowing a secure en bloc resection. In 9 cases the malignant growth was localized in the upper level infiltrated the anterior skull base and required a craniofacial resection. An alternative to transfacial resection of nasal and sinus tumors was the midfacial degloving technique. Without creating visible facial scars we were able to resect reliably 5 malignancies of the middle level that extended in part to the sphenoid sinus and the nasopharynx. Complications occurred in 2 cases. When also considering non-malignant tumors (n=42), the following complications occurred with this technique: stenosis of the lacrimal duct, stenosis of the nasal vestibule and a perceptive disorder of the infraorbital nerve. Endonasal surgery was restricted to small malignancies of the nasal cavity. In contrast, surgical treatment of advanced tumors required a wide and clear three-dimensional exposure for an oncologically secure resection.