title: Indication for and Limitation of the Facial Dismasking Flap Approach for Skull Base Surgery to Achieve the Best Esthetical and Functional Results.
abstract: BACKGROUND
  The facial dismasking flap (FDF) approach to operations on the deep skull base region consists of a coronal incision and a circumpalpebral incision. This approach provides a wide surgical field for extirpation of deep extended craniofacial tumors without leaving any undesirable scars on the face. Therefore, the FDF approach can provide satisfactory esthetical and functional results. Meanwhile, in some cases, especially in patients with a history of skull base surgery or orbital extension, patients are not fully satisfied even when the FDF approach is used. In this study, we evaluated the indication for and limitation of the FDF approach.
  
  
  METHODS
  We reviewed 26 patients who underwent the FDF approach for skull base surgery. The patients were 16 men and 10 women, and average age was 37 years. Of these patients, 21 were treated using a hemi-FDF approach, and the remaining 5 were subjected to a bilateral FDF approach. Patients were divided into 2 groups in this study: group A (11 patients), patients with no history of skull base surgery and orbital extension; and group B (15 patients), patients with a history of skull base surgery and/or orbital extension.
  
  
  RESULTS
  There was no FDF loss or facial palsy in either group A or group B. In group A, there was no lagophthalmos or scar contracture of the eyelid. In group B, there were 5 cases (33%) of ectropion and lagophthalmos and 7 of eyelid scar contracture (46%). As for esthetical evaluation, group B showed a significantly higher rate of facial asymmetry than group A. Moreover, in group A, the total ratings for above average reached 90.9%, whereas in group B, nearly half of the patients (48.9%) gave ratings of fair and poor.
  
  
  CONCLUSIONS
  The FDF approach could be a good option for skull base surgery. In particular, patients without a history of skull base surgery and orbital extension could obtain satisfactory esthetical and functional outcomes. However, the procedure had limited effectiveness for patients with a history of skull base surgery or orbital extension because esthetical and functional outcomes inevitably became worse.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, †Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo; ‡Department of Neurosurgery and Head, and §Department of Neck Surgery, Kameda Medical Center, Chiba, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yano
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Okazaki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Atsunobu
authors.initials: A
authors.lastname: Tsunoda
authors.forename: Masaru
authors.initials: M
authors.lastname: Aoyagi
authors.forename: Seiji
authors.initials: S
authors.lastname: Kishimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004954:Esthetics; D005145:Face / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D055815:Young Adult