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William J. Richtsmeier, MD, PhD; Robert J. S. Briggs, FRACS; Wayne M. Koch, MD; David W. Eisele, MD; Mark C. Loury, MD; John C. Price, MD; Douglas E. Mattox, MD; Benjamin S. Carson, MD

Arch Otolaryngol Head Neck Surg. 1992;118(9):913-917.

Abstract
• Objective.—To evaluate the complications of anterior craniofacial resection and correlate their impact with tumor control status.

Design.—We conducted a retrospective review of 32 consecutive, operable patients' records seen over a 6-year period, requiring 35 procedures.

Setting.—Academic tertiary referral medical center.

Participants.—Twenty-six patients (81%) had malignant lesions (esthesioneuroblastoma, squamous cell carcinoma, and a group of miscellaneous malignant tumors). Six patients had various benign neoplasms.

Intervention.—The surgical approach involved bifrontal craniotomy coupled with lateral rhinotomy in 19 cases (61%), facial degloving in 10 cases (32%), a total rhinectomy in one case, and endoscopic sinusectomy without facial incision in two cases.

Outcome Measure.—Clinically noted complications and oncologic outcome.

Results.—There was one avoidable perioperative death indirectly associated with the patient's procedure. Nine patients suffered significant intracranial neurological complications such as tension pneumocephalus and delayed epidural abscess. All of these complications were managed successfully. Of patients with malignant tumors, 13 (52%) are alive with no evidence of disease and one is alive with recurrence after a mean follow-up period of 28.9 months. The 10 patients who succumbed to disease had a mean postoperative survival of 22.9 months.

Conclusions.—In contrast to the perspective of only a decade ago, we conclude that craniofacial resection is a relatively safe, versatile, and effective procedure for surgical management of tumors involving the anterior skull base.

(Arch Otolaryngol Head Neck Surg. 1992;118:913-917)

Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery (Drs Richtsmeier, Briggs, Koch, Eisele, Loury, Price, and Mattox) and Neurological Surgery (Drs Mattox and Carson), The Johns Hopkins University School of Medicine, Baltimore, Md.

Footnotes
Accepted for publication June 17, 1992.

Reprint requests to Department of Otolaryngology—Head and Neck Surgery, The Johns Hopkins Medical Institutions, 600 N Wolfe St, Carnegie 469, Baltimore, MD 21205 (Dr Koch).

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