Morbidity Profile and Functional Outcome of Modified Facial Translocation Approaches for Skull Base Tumors

ABSTRACT

The primary objective of this study was to evaluate morbidity associated with facial translocation approaches for skull base and results of various technical modifications. Forty consecutive patients who underwent facial translocation approaches for accessing skull base tumors from July 2005 to June 2010 were included in this study. There were 25 patients who underwent standard facial translocation, 4 patients medial mini, and 11 patients underwent extended facial translocation. Thirteen patients had benign disease and 27 patients had malignant disease. Resection was R0 in 36 and R1 in 4 patients. Most patients had acceptable cosmetic results. None of the patients had problems related to occlusion or speech and swallowing. The commonest complication observed was nasal crusting in 16 patients. Grade 2 trismus and exposure of mini plate was seen in three patients. Two patients developed necrosis of translocated bone. Three patients developed palatal fistula before modification of palatal incision. Facial translocation provides a satisfactory access for adequate clearance of skull base tumors with satisfactory aesthetic and functional results. With modifications of the surgical technique and implementation of new surgical tools, the morbidity of facial translocation approaches will continue to decrease.

KEYWORDS

Facial translocation approach - morbidity - skull base - infratemporal fossa

REFERENCES

• 1 Janecka I P, Sen C N, Sekhar L N, Arriaga M. Facial translocation: a new approach to the cranial base.  Otolaryngol Head Neck Surg. 1990;  103 (3) 413-419
• 2 Wei W I, Lam K H, Sham J S. New approach to the nasopharynx: the maxillary swing approach.  Head Neck. 1991;  13 (3) 200-207
• 3 Fisch U. The infratemporal fossa approach for nasopharyngeal tumors.  Laryngoscope. 1983;  93 (1) 36-44
• 4 Tu G Y, Hu Y H, Xu G Z, Ye M. Salvage surgery for nasopharyngeal carcinoma.  Arch Otolaryngol Head Neck Surg. 1988;  114 (3) 328-329
• 5 Chatni S S, Sharan R, Patel D, Iyer S, Tiwari R M, Kuriakose M A. Transmandibular approach for excision of maxillary sinus tumors extending to pterygopalatine and infratemporal fossae.  Oral Oncol. 2009;  45 (8) 720-726
• 6 Falcon R T, Rivera-Serrano C M, Miranda J F et al.. Endoscopic endonasal dissection of the infratemporal fossa: Anatomic relationships and importance of eustachian tube in the endoscopic skull base surgery.  Laryngoscope. 2011;  121 (1) 31-41
• 7 Janecka I P. Classification of facial translocation approach to the skull base.  Otolaryngol Head Neck Surg. 1995;  112 (4) 579-585
• 8 Thankappan K, Sharan R, Iyer S, Kuriakose M A. Esthetic and anatomic basis of modified lateral rhinotomy approach.  J Oral Maxillofac Surg. 2009;  67 (1) 231-234
• 9 Kuriakose M A, Trivedi N P, Kekatpure V. Anterior Skull base Surgery.  Ind J Surg Oncol. 2010;  1 133-145
• 10 Lyons B M, Donald P J. Radical surgery for nasal cavity and paranasal sinus tumors.  Otolaryngol Clin North Am. 1991;  24 (6) 1499-1521
• 11 Hao S P, Tsang N M, Chang C N. Salvage surgery for recurrent nasopharyngeal carcinoma.  Arch Otolaryngol Head Neck Surg. 2002;  128 (1) 63-67
• 12 Williams W G, Lo L J, Chen Y R. The Le Fort I-palatal split approach for skull base tumors: efficacy, complications, and outcome.  Plast Reconstr Surg. 1998;  102 (7) 2310-2319
• 13 Kuriakose M A, Sorin A, Sharan R, Fishman A J, Babu R, Delacure M D. Quantitative evaluation of transtemporal and facial translocation approaches to infratemporal fossa.  Skull Base. 2008;  18 (1) 17-27
• 14 Hao S P, Pan W L, Chang C N, Hsu Y S. The use of the facial translocation technique in the management of tumors of the paranasal sinuses and skull base.  Otolaryngol Head Neck Surg. 2003;  128 (4) 571-575
• 15 Hao S P. Facial translocation approach to the skull base: the viability of translocated facial bone graft.  Otolaryngol Head Neck Surg. 2001;  124 (3) 292-296
• 16 Sharan R, Iyer S, Chatni S S et al.. Increased plate and osteosynthesis related complications associated with postoperative concurrent chemoradiotherapy in oral cancer.  Head Neck. 2008;  30 (11) 1422-1430
• 17 Suárez C, Llorente J L, Muñoz C, García L A, Rodrigo J P. Facial translocation approach in the management of central skull base and infratemporal tumors.  Laryngoscope. 2004;  114 (6) 1047-1051
• 18 Wei W I, Ho C M, Yuen P W, Fung C F, Sham J S, Lam K H. Maxillary swing approach for resection of tumors in and around the nasopharynx.  Arch Otolaryngol Head Neck Surg. 1995;  121 (6) 638-642
• 19 Ng R W, Wei W I. Quality of life of patients with recurrent nasopharyngeal carcinoma treated with nasopharyngectomy using the maxillary swing approach.  Arch Otolaryngol Head Neck Surg. 2006;  132 (3) 309-316
• 20 Kassam A B, Prevedello D M, Carrau R L et al.. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients.  J Neurosurg. 2010;  (December) 17 [Epub ahead of print]