title: Facial dismasking flap for removal of tumors in the craniofacial region.
abstract: OBJECTIVE
  This study was aimed at estimating the usefulness of the facial dismasking flap for craniofacial surgery.
  
  
  METHODS
  Anatomical study and retrospective case study.
  
  
  METHODS
  The facial dismasking flap is a combination of a coronal skin incision and a circumpalpebral incision. By adding a circumpalpebral incision, the skin can be detached from the orbital structures and the coronal skin flap can be elevated more inferiorly together with the facial nerves and muscles. We retrospectively reviewed patients who underwent the facial dismasking flap with regard to the extent of the surgical field and resectability under this flap. Postoperative facial scarring and movements were also evaluated. Facial palsy was estimated according to the House-Brackmann grading system.
  
  
  RESULTS
  Twenty-three patients with tumors in various locations, such as, the nasal cavity, paranasal sinus, zygoma, and infratemporal fossa, who had undergone a facial dismasking flap, were studied. Sufficient surgical fields were obtained for removal of the tumor in all patients. Tumors were totally resected in 21 patients and were subtotally resected in two patients to avoid optic nerve damage. Facial nerves were anatomically preserved and facial scarring was minimal in all patients. No facial palsy remained in any patients except one who showed a deterioration of the facial palsy (House-Brackmann grade V-VI).
  
  
  CONCLUSIONS
  This flap allows the surgeon to obtain wide exposure of the upper two-thirds of the facial skull. Moreover, damage to the facial skin is minimal and facial movements are well preserved. This technique is not well known to head and neck surgeons, and this is the first comprehensive report of this technique applied to removal of craniofacial lesions.
authors.affiliation: Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Koda
authors.forename: Atsunobu
authors.initials: A
authors.lastname: Tsunoda
authors.forename: Hideo
authors.initials: H
authors.lastname: Iida
authors.forename: Keiichi
authors.initials: K
authors.lastname: Akita
authors.forename: Seiji
authors.initials: S
authors.lastname: Kishimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005145:Face / Q000601:surgery*; D005149:Facial Expression; D005153:Facial Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005158:Facial Paralysis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010255:Paranasal Sinus Neoplasms / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000453:epidemiology / Q000601:surgery*; D013524:Surgical Flaps; D013701:Temporal Bone / Q000601:surgery