A surgical approach as dysmasking in patients with malignant tumors of the paranasal sinuses and skull base

A surgical approach as dysmasking implies a bitemporal skin incision followed by a single flap from upper facial soft tissues. The advantages of this technique may include a wide surgical approach to the structures of the anterior skull base, a possibility of intraoperative extension of the approach through parapalpebral and/or pre-auricular incisions, the lack of incisions in the central zone of the face, the preservation of the integrity of mimic muscles and the sensitivity of soft tissues in the central zone of the face. This paper gives experience in surgically treating 5 patients with malignant tumors of the paranasal sinuses and skull base. All the cases required a wide approach to the skull base and anterior facial skeleton. This was achieved by the use of the dysmasking approach, if need be, parapalpebral incisions or facial nerve resection followed by single-stage microsurgical neurorrhaphy were made. All operations were performed under endotracheal anesthesia. The wide surgical approach to the tumor, which permitted its removal in the maximum volume without skin incisions in the central zone of the face, as vitally indicated, could be achieved by dysmasking that yielded satisfactory postoperative cosmetic and functional results in all the cases.

1. Barnes E.L., Kapadia S.B., Nemzek W.R. et al. Biology of selected skull base tumors. In book: Skull base surgery. By eds.: I.P. Janecka, K. Tiedemann. Philadelphia, Pa: Lippincott-Raven, 1997. Pp. 263–92.

2. Vrionis F.D., Kienstra M.A., Rivera M., Padhya T.A. Malignant tumors of the anterior skull base. Cancer Control 2004;11(3):144–51.

3. Мудунов А.М. Проблемы диагностики и лечения опухолей основания черепа и подвисочной ямки. Вестник РОНЦ им. Н.Н. Блохина РАМН, 2006;17(1):20–8. [Мudunov А.М. Problems of diagnosis and treatment of skull base and the intratemporal fossa tumors. Vestnik RONC im. N.N. Blokhina RAMN = Bulleten of N.N. Blokhin Russian Cancer Research Center at RAMS, 2006;17(1):20–8. (In Russ.)].

4. Grégoire V., Lefebvre J.-L., Licitra L. et al. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21(Suppl 5): v184–6.

5. Вдовина С.Н., Андреев В.Г., Буякова М.Е. и др. Лечение рака полости носа и околоносовых пазух. Мультидисциплинарный подход к лечению опухолей головы и шеи: материалы конференции, посвященной памяти профессора Г.В. Фалилеева. 29–30 сентября 2011 г., Москва. С. 16. [Vdovina S.N., Andreev V.G., Buyakova М.Е. etc. Treatment of the cancer of the nasal cavity and of paranasal sinuses. Мultidisciplinary approach to the treatment of head and neck tumors: materials of the conference, dedicated to the memory of professor G.V. Falileev. Моscow, September 29–30, 2011. P. 16. (In Russ.)].

6. Iyer N.G., Tan D.S.W., Tan V.K. et al. Randomized trial comparing surgery and adjuvant radiotherapy versus concurrent chemoradiotherapy in patients with advanced, nonmetastatic squamous cell carcinoma of the head and neck: 10-year update and subset analysis. Cancer 2015;121:3560.

7. Jégoux F., Métreaua A., Louvel G., Bedfert C. Paranasal sinus cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2013;130(6):327–35.

8. McKinnon J.G., Kokal W.A., Neifeld J.P., Kay S. Natural history and treatment of mucosal melanoma. J Surg Oncol 1989;41(4):222–5.

9. Stern S.J., Guillamondegui O.M. Mucosal melanoma of the head and neck. Head Neck 1991;13(1):22–7.

10. Batsakis J.G., Rice D.H. The pathology of head and neck tumors: Vasoformative tumors, part 9B. Head Neck Surg 1981;3(4):326–39.

11. Surgery of the paranasal sinuses. By eds.: A. Blitzer, W. Lawson, W.H. Freidman. Philadelphia: WB Saunders, 1985. Pp. 105–7.

12. Enzinger F.H., Smith B.H. Hemangiopericytoma. An analysis of 106 cases. Hum Pathol 1976;7(1):61–82.

13. Барышев В.В., Андреев В.Г., Акки Э.Д. Возможности реконструкции орбиты у онкологических больных (обзор литературы). Сибирский онкологический журнал 2012;53(5):80–4. [Baryshev V.V., Аndreev V.G., Аkki E.D. Possibilities of the orbital cavity reconstruction in oncologic patients (literature review). Sibirskiy Onkologicheskiy Zhurnal = Siberian Oncologic Journal 2012;53(5):80–4. (In Russ.)].

14. Gorenstein A., Facer G.W., Weiland L.H. Hemangiopericytoma of the nasal cavity. Otolaryngology 1978;86(3 Pt 1):ORL405–15.

15. Abdel-Fattan H.M., Adams G.L., Wick M.R. Hemangiopericytoma of the maxillary sinus and skull base. Head Neck 1990;12(1):77–83.

16. Cranial, craniofacial and skull base surgery. By eds.: P. Cappabianca, L. Califano, G. Iaconetta. Springer, 2010.

17. Derome P. The transbasal approach to tumors invading the base of the skull. Operative neurosurgical techniques. By eds.: H. Schmidek, W. Sweet. Grune & Stratton, 1988. Pp. 619–33.

18. Kawakami K., Kawamoto K., Tsuji H. Opening of the carotid canal in the skull base surgery: drilling of the carotid canal triangle. No Shinkei Geka 1993;21(11):1013–9.

19. Wigand M.E., Iro H., Bozzato A. Transcranial combined neurorhinosurgical approach to the paranasal sinuses for anterior skull base malignancies. Skull Base 2009;19(2):151–8.

20. Har-El G., Todor R. Endoscopic Craniofacial Approach for Intracranial Polyposis: The “Blue-Sky Technique”. Skull Base 2003;13(4):235–9.

21. Jones W.D. 3rd, Whitaker L.A., Mutagh F. Applications of reconstructive craniofacial techniques to acute craniofacial trauma. J Trauma 1977;17(5):339–43.

22. Shumrick K.A. Recent advances and trends in management of maxillofacial and frontal trauma. Facial Plast Surg 1993;9(1):16–28.

23. Stanley R.B. Jr. The zygomatic arch as a guide to reconstruction of comminuted malar fractures. Arch Otolaryngol Head Neck Surg 1989;115(12):1459–62.

24. Gruss J.S. Complex nasoethmioid-orbital and midfacial fractures: role of craniofacial surgical techniques and immediate bone grafting. Ann Plast Surg 1986;17(5):377–90.

25. Ueda K., Tajima S., Oba S. et al. Recovery of forehead sensation after extended coronal flap or “dismasking flap”. Eur J Plast Surg 2000;23:146–9.

26. Kyutoku S., Kawakami K., Tsuji H. et al. Hemifacial dismasking flap for anterior skull base tumor – technical note. Neurol Med Chir (Tokyo) 1996;36(9):666–9.

27. Salmon M. Arteries of the skin. By eds.: G.I. Taylor, M.N. Tempest. London: Churchill Livingstone, 1988. Pp. 72–84.

28. Walch C., Stammberger H., Anderhuber W. et al. The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment. Laryngoscope 2000;110(4):635–40.

29. Har-El G. Anterior craniofacial resection without facial skin incisions – a review. Otolaryngol Head Neck Surg 2004;130(6):780–7.

30. Krischek B., Carvalho F.G., Godoy B.L. et al. From craniofacial resection to endonasal endoscopic removal of malignant tumors of the anterior skull base. World Neurosurg 2014;82(6 Suppl):S59–65.

31. Scholz M., Parvin R., Thissen J. et al. Skull base approaches in neurosurgery. Head Neck Oncol 2010;2:16.

32. Martins C., Costa E., Silva I.E., Campero A. et al. Microsurgical anatomy of the orbit: the rule of seven. Anat Res Int 2011;2011:468727.