Atypical facial access: an unusually high prevalence of use among patients with skull base tumors treated at 2 centers.
OBJECTIVE
To analyze the influence of the unique percentage of skin carcinomas with skull base invasion on the choice of the facial surgical approach.


METHODS
Multi-institutional retrospective analysis of the medical charts of all patients who had undergone oncological craniofacial operations from 1981 to 2005. Data were collected on demographic distribution, location of the primary tumor, histologic type, type of operation, reconstruction, complications, and outcome. Special attention was directed toward the choice of facial approach.


METHODS
Two major tertiary care centers.


METHODS
A total of 484 patients who had undergone major skull base operations.


METHODS
Frequency of atypical facial approaches.


METHODS
Impact on the need for more sophisticated reconstructions and on surgical morbidity.


RESULTS
During this 25-year period, 484 patients underwent major skull base operations in the 2 centers; data concerning 467 cases were available for analysis. The median age of the patients was 52.8 years (range, 4-88 years), and the male-female ratio was 1.9:1.0. The initial location of the tumor was the craniofacial skin in 63.5% of cases, ethmoid in 10.8%, maxilla in 2.3%, orbit in 1.9%, and other origins, including endocranial, in 19.4%. The histologic type of the lesions was basal cell carcinoma in 42.0% of cases, squamous cell carcinoma in 29.5%, esthesioneuroblastoma in 5.3%, adenocarcinoma in 3.9%, adenoid cystic carcinoma in 2.8%, and other types in 16.5%. Owing to this high prevalence of advanced skin carcinomas, the most commonly employed facial approach was atypical, tailored to encompass all compromised skin and underlying tissues, in 55.5% of cases, followed by the Weber-Ferguson approach, with all its variations (eg, nasal swing) in 17.8%, lateral rhinotomy in 12.2%, facial translocation in 3.8%, and other facial techniques in 7.7%. No facial approach was required in 1.5% of cases.


CONCLUSIONS
In most situations, head and neck surgeons chose an atypical surgical approach to properly resect all facial structures invaded by very advanced skin cancers.
Cernea
Claudio Roberto
CR
Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. cerneamd@uol.com.br
Dias
Fernando L
FL
Lima
Roberto Araujo
RA
Farias
Terence
T
Mendonça
Ullyanov B T
UB
Vellutini
Eduardo
E
Gomes
Marcos Q T
MQ
Nogueira
Janio
J
Lorencetti
Renata R G
RR
Brandão
Lenine Garcia
LG
Dos Santos
Luiz R M
LR
Morais-Besteiro
Julio
J
Ishida
Luiz Carlos
LC
Galvão
Mario S L
MS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*