title: Retrospective assessment of the dismasking flap procedure as a craniofacial approach.
abstract: OBJECTIVE
  In 1997 the authors presented the case of a 3-year-old girl who underwent complete resection of a huge tumor via a new technique using a dismasking flap. Since that report, 14 patients have undergone surgery using this technique. There have been few reports on long-term follow-up after a craniofacial surgical approach and reconstruction of a huge tissue defect. The authors report details of this procedure based on these cases, including long-term follow-up in the original case.
  
  
  METHODS
  The dismasking flap is a cranioorbitofacial degloving method that uses a circumpalpebral approach with or without piriform margin incisions and presents a wide surgical field under direct vision. Fourteen patients have undergone surgery using the dismasking flap technique. These patients had multiple craniofacial bone fractures (3 cases) and malignant or premalignant craniofacial tumors (11 cases). Patients ranged in age from 3 to 62 years old. The longest follow-up period was 15 years. The results of these cases are reported regarding changes in the facial bones and soft tissues with growth, the various pathologies involved, and complications.
  
  
  RESULTS
  Complications using this approach were lagophthalmos with ectropion of the lower eyelid, disturbance of the superior orbital nerve, disturbance of the inferior orbital nerve, maxillary hypoplasia, and blepharoptosis. In all affected patients these complications were almost always temporary. In 2 of the 14 cases, a repair operation for lagophthalmos was necessary, while others showed spontaneous improvement approximately 6 months to a year after the procedure. In the case with the longest follow-up duration, the patient's nose is asymmetrical, especially the alar portion, due to hypoplasia of the grafted bone and/or the fixation with titanium miniplates.
  
  
  CONCLUSIONS
  This flap is very useful for en bloc resection of huge skull base tumors, multiple craniofacial bone fractures, and as a lateral approach to a deep portion of the middle cranial base. Careful attention is necessary, however, because one may encounter unexpected complications if one does not ensure adequate protection of the perioperative flap. Meticulous postoperative management is also essential.
authors: Department of Plastic and Reconstructive Surgery, Osaka City General Hospital, Osaka, Japan.
authors: Takuya
authors: T
authors: Fujimoto
authors: Keisuke
authors: K
authors: Imai
authors: Makoto
authors: M
authors: Takahashi
authors: Takaharu
authors: T
authors: Hatano
authors: Motoki
authors: M
authors: Tamai
authors: Tomoaki
authors: T
authors: Nakano
authors: Hiroaki
authors: H
authors: Sakamoto
authors: Kenji
authors: K
authors: Ohata
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005145:Face / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000601:surgery; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D055815:Young Adult