Transfacial Surgery Research Articles

Transfacial versus endoscopic approach in the treatment of woodworker's nasal adenocarcinomas

The purpose of this study was to present a monocentric retrospective study designed to compare oncologic results and morbidity between transfacial surgery and endoscopic endonasal surgery for nasal adenocarcinomas. Between 1998 and 2003, 31 patients were operated on via transfacial surgery, and between 2004 and 2009, 43 patients were operated on via endoscopic endonasal surgery. Overall and specific survival, local control, and morbidity (length of hospitalization, intensive care unit [ICU] monitoring, need for nasal packing, and complications) were compared. There was no difference in prognostic factors between groups, but the median age was significantly higher for endoscopic endonasal surgery. Three-year overall survival, specific survival, and local control were not different between groups (respectively, 76.7%, 86%, and 81.4% for endoscopic endonasal surgery vs 61.3%, 67.7%, and 71% for transfacial surgery). Morbidity was significantly lower with endoscopic endonasal surgery for all criteria. Endoscopic surgery may replace transfacial surgery in the treatment of woodworker's adenocarcinomas. Older patients can be operated on by decreasing morbidity and mortality with at least similar oncologic results.

Surgical management of recurrent sinonasal mucosal melanoma: endoscopic or transfacial resection.

Sinonasal mucosal melanoma (SNMM) is associated with poor prognosis. Local recurrence is common and represents a major problem in the therapy. Wide resection surgery is usually applied. However, given the almost futile prognosis, optimal symptom control may be preferable to wide resection at all costs. The aim of our study was to analyze the outcome in patients with recurrent SNMM treated by transfacial radical surgery or by a less invasive endoscopically controlled approach. Patients with recurrent grade III or IV staged SNMM who presented to our ENT department between 2000 and 2010 were either treated by transfacial (n = 10) or endoscopically controlled surgery (n = 12). The patients' charts were reviewed for clinical symptoms, relapse-free time and survival time. Clinical symptoms improved after surgery. The morbidity after endoscopic surgery was significantly lower than after transfacial surgery. The chosen surgical technique did neither affect relapse-free nor survival time. When treating recurrent SNMM, the comparatively gentle and less mutilating endoscopic approach proved to be a sufficient surgical procedure, being not inferior to aggressive surgery with respect to recurrence and survival rate.

El posible verdadero origen de la metodología transfacial

Despite technological advances in a globalized world conflicts always arise about authorship of scientific procedures. To help resolve the conflicts that arise about the origin of transfacial surgery we have been entertained with bibliographical support to organize the aspects of a possible origin and author as it is understood today. Without forgetting people in history that in the XIX century foreshadowed and provided ideas from which we could determine who was the first to write the content and true possibilities. Putting those who incorporated the procedure late, with pretensions of protagonism in their place.

Fibrome cémento-ossifiant psammomateux nasoéthmoïdal à extension orbitaire

Psammomatoid cemento-ossifying fibroma (PCOF) is a rare benign fibro-osseous lesion. It affects the maxilla, the nasal cavity, paranasal sinuses, and the ethmoid. It is slow-growing, progressive, and benign but it can be locally extended and mimic a malignant tumor. We report the unusual case of a 36-year-old woman with a nasal and ethmoid PCOF with orbital and endocranial extension. The tumor was revealed by exophthalmia and nasal obstruction. The diagnosis was proven histologicaly on biopsies. The treatment was transfacial surgery. There was no recurrence 1 year later. Intraorbital and endocranial extension of PCOF are rare aggressive behaviours. Histologically, the differential diagnosis is difficult between fibrous dysplasia or psammomatoid meningioma. Complete surgical excision is necessary to prevent recurrence.

Aesthetic Outcome of Transfacial Sinus Surgery

To investigate the patient's view of the cosmetic outcome of transfacial sinus surgery. Prospective survey of patients after transfacial sinus surgery in a tertiary referral academic otolaryngology department. Academic outpatient clinic of otorhinolaryngology. Patients Seventy patients (52 men, 18 women; mean +/- SD age, 56.2 +/- 14.9 years) who had undergone transfacial sinus surgery more than 4 months prior to study entry. Standardized patient self-assessment for postoperative alteration of facial appearance and emotional impairment and standardized observer assessment by surgeons and laypersons by means of visual analogue scales. Seventy-nine percent of the patients rated their appearance unaltered or minimally altered after transfacial surgery, and 91% reported no or minimal cosmetic morbidity. Postoperative cosmetic morbidity was significantly more common in women, in patients with chronic disease, and in those operated on for trauma. The surgeons' assessment was significantly correlated with the patients' self-assessment of altered appearance, but not with the patients' emotional impairment. Consideration of these risk factors may help to further improve patient selection for, and patients' satisfaction with, transfacial sinus surgery.

Informations-assistierte Chirurgie als ein transdisziplinäres Operationsverfahren

Information assisted surgery (IAS) is a further development of the computer assisted surgery (CAS) exclusively for intraoperative localization serving as basis for future technologies such as mechatronic and robotic. It requires of the surgeon a turnaround from traditional surgical proviso as well as transdisciplinary knowledge in the areas of surgical medicine, radiological imaging and information. The advantage of IAS is the predictability of the surgical procedure according to the specifications of modern quality assessment. We analyzed the possibilities for the application of IAS in interdisciplinary transfacial surgery of the frontobasis in 9 patients with different pathologies of the central skull base and the cranio-cervical junction and compared this to conventional CAS. We determined retrospectively with a quality assessment analysis that surgery planning is too time consuming in the moment, and that the necessary transdisciplinary knowledge for IAS cannot be taken for granted yet. IAS has not been consequently applied for the entire surgery process in any of the 9 cases. This was due to technical difficulties as well as large intraoperative accuracy deviations of more than 5 mm. Even though the highly-developed technology of IIAS -- intelligent information assisted surgery -- is available, with the possibility of half or fully automatic implementation of IIAS including a automatic re-referencing, this technology will not be used in medical navigation for strategic reasons.

Clinical application of the classification scheme of transfacial approaches

Between 1990 and 1998, 63 patients (39 men and 24 women) underwent a transfacial approach. Based on the level I through level VI classification scheme developed by the Barrow Neurological Institute Skull Base Team, 83 transfacial procedures were performed: 49 procedures involved a single level, 8 involved a level III approach combined with a level V approach, and 3 involved a level I through III aoproach combined with either a pterional craniotomy or orbitozygomatic craniotomy. Eleven procedures were performed in a staged fashion. Thirty-five different pathologies were addressed: Chordomas (7), angiofibromas (7), and pituitary macroadenomas (5) were most common. One patient (1.6%) died postoperatively. Overall, 29 (46%) patients experienced complications after transfacial surgery. Six (9.5%) patients experienced major complications, and 23 (36.5%) patients experienced minor complications. The transfacial surgeries were without complications in 34 (54%) patients. This large series demonstrates the versatility of transfacial skull base approaches for treating benign and malignant lesions. The procedures are associated with good patient outcomes and an acceptable rate of complications.

Complications of endonasal paranasal sinus surgery--diagnostic and therapeutic consequences

Functional endoscopic sinus surgery has been proven the therapeutic method of choice in surgical therapy of chronic sinusitis. On the other hand, endonasal sinus surgery may cause severe complications even when performed by a skilled surgeon. This is easily explained by the close vicinity of many functionally important structures to the operative site. Three histories are reported that involve possible complications even in apparently simple cases. Diagnostic and therapeutic consequences are discussed. In a case previously diagnosed histologically as chronic unspecific sinusitis, an endonasal biopsy resulted in endocranial bleeding requiring neurosurgical intervention. Midline granuloma was found to be the correct diagnosis. Another patient was seen with a normal X-ray of the sinuses and solitary polypoid structure in his left nose. Polypectomy was planned and a CT scan was performed, which demonstrated a meningocele. Transfacial surgery was then performed to remove the meningocele. Another patient presented with a traumatic impression of the frontal sinus, and open reposition by transfacial surgery of the frontal and ethmoid sinus was planned. When CT scans revealed an uncovered optic nerve in the sphenoid sinus of the fractured side, we abandoned ethmodectomy and performed reposition of the frontal sinus as the only surgical procedure. In this paper, we show typical complications of endonasal sinus surgery and strategies for avoiding them. If any complication occur, prompt treatment is required. Three groups of complications can be defined: perforation of frontobasal dura resulting in cerebrospinal fluid (CSF) fistula, severe bleeding, and orbital or optic nerve injury. When the surgeon discovers an intraoperative complication, possible consequences must be considered immediately to minimize side effects for the patient. A CSF fistula should be closed in the same procedure, and transfacial surgery may be necessary. Hemorrhage resulting from an ethmoidal artery may require frontoorbital surgery and ligation of this vessel. If retrobulbar hemorrhage caused by retraction of an ethmoid artery occurs, immediate intervention is necessary. Usually a transfacial approach, resection of the medial orbital wall and retrobulbar decompression are performed. In some cases lateral canthotomy may be the best way to drain haematoma and decompress the optic nerve. Subsequently, orbital revision and ligation of the retracted artery must be performed. Any delay can result in persistent visual loss. We conclude that the extranasal frontoorbital approach should be part of the residency training program in ENT departments. Any surgeon performing endonasal sinus surgery must be trained in transfacial emergency procedures, which should be part of anatomic preparations in teaching courses, thus avoiding severe damage in case of intraoperative complication.