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Skull base surgery. 1999; 9(1): 41–46.
PMCID: PMC1656724

Midline Anterior Craniofacial Approach for Malignancy

Results of En Bloc Versus Piecemeal Resections


Thirty consecutive cases of midline anterior craniofacial procedures for the treatment of malignant neoplasms arising from the paranasal sinuses were reviewed. Posterior and lateral base craniofacial procedures were specifically excluded. This review compares the results, in terms of survival and major complication rate, between en bloc and piecemeal resections. The average follow-up was 4 years and 3 months. Sixteen patients were treated with an en bloc resection. The major complication rate was 31%. One-year survival rate was 94% for the en bloc resection group, 67% for patients with positive margins, and 100% for patients with clear margins. Three-year survival for en bloc resection dropped to 56, 33, and 67%, respectively. Fourteen patients were treated with piecemeal resections. The major complication rate was 21%. One-year survival rate was 83% for the piecemeal resection group, 60% for patients with positive margins, and 100% for patients with clear margins. Three-year survival dropped to 70, 60, and 80%, respectively. Although it is considered desirable to obtain an en bloc resection in some craniofacial procedures, we conclude that a piecemeal resection is a viable alternative in situations where an en bloc procedure is difficult to obtain safely.

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Selected References

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  • Biller HF, Slotnick DB, Lawson W, Green RP. Superior rhinotomy for en bloc resection of bilateral ethmoid tumors. Arch Otolaryngol Head Neck Surg. 1989 Dec;115(12):1463–1466. [PubMed]
  • Lund VJ, Harrison DF. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses. Am J Surg. 1988 Sep;156(3 Pt 1):187–190. [PubMed]
  • Osguthorpe JD, Patel S. Craniofacial approaches to sinus malignancy. Otolaryngol Clin North Am. 1995 Dec;28(6):1239–1257. [PubMed]
  • Plinkert PK, Zenner HP. Transfazialer Zugang, kraniofaziale Resektion und Midfacial Degloving bei der Chirurgie bösartiger Tumoren der vorderen Schädelbasis und der angrenzenden Nasennebenhöhlen. HNO. 1996 Apr;44(4):192–200. [PubMed]
  • Raveh J, Turk JB, Lädrach K, Seiler R, Godoy N, Chen J, Paladino J, Virag M, Leibinger K. Extended anterior subcranial approach for skull base tumors: long-term results. J Neurosurg. 1995 Jun;82(6):1002–1010. [PubMed]
  • Ketcham AS, Van Buren JM. Tumors of the paranasal sinuses: a therapeutic challenge. Am J Surg. 1985 Oct;150(4):406–413. [PubMed]
  • Levine PA, Scher RL, Jane JA, Persing JA, Newman SA, Miller J, Cantrell RW. The craniofacial resection--eleven-year experience at the University of Virginia: problems and solutions. Otolaryngol Head Neck Surg. 1989 Dec;101(6):665–669. [PubMed]
  • McCaffrey TV, Olsen KD, Yohanan JM, Lewis JE, Ebersold MJ, Piepgras DG. Factors affecting survival of patients with tumors of the anterior skull base. Laryngoscope. 1994 Aug;104(8 Pt 1):940–945. [PubMed]
  • Terz JJ, Young HF, Lawrence W., Jr Combined craniofacial resection for locally advanced carcinoma of the head and neck II. Carcinoma of the paranasal sinuses. Am J Surg. 1980 Nov;140(5):618–624. [PubMed]
  • Deschler DG, Gutin PH, Mamelak AN, McDermott MW, Kaplan MJ. Complications of anterior skull base surgery. Skull Base Surg. 1996;6(2):113–118. [PMC free article] [PubMed]
  • Shah JP, Kraus DH, Arbit E, Galicich JH, Strong EW. Craniofacial resection for tumors involving the anterior skull base. Otolaryngol Head Neck Surg. 1992 Apr;106(4):387–393. [PubMed]

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