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Craniofacial Resection

Craniofacial Resection

Fig.1 MRI shows tumour (olfactory neuroblastoma) involving left ethmoid (green arrow) with intracranial extension (yellow arrow). White arrow points at the level of skullbase.
Fig.2 Diagram shows extent of resection. en-bloc resection of ethmoid, septum and floor of anterior cranial fossa done for ethmoid tumour (green line). If the tumour, in addition, involves maxilla, the resection includes maxilla (blue line).
Fig.3 Diagram shows standard incisions for open craniofacial resection – Coronal incision (1) and lateral rhinotomy incision (2). Additional extensions (2a & 2b) are made if maxilla is included in the excision.
Fig.4 Coronal incision extends from one preauricular area to another, well behind the hairline to get sufficienr length of pericranial flap. Lateral rhinotomt incision is modified as marked which gived better scar and cosmesis.
Fig.5 Medial maxillectomy in progress. White arrow points at the osteotomy site at the anterior wall of maxilla. Medial wall of orbit is being retracted with a malleable retractor exposing the medial wall of orbit (yellow arrow).
Fig.6 Pericranial flap of sufficient length based on supratrochlear and supraorbital vessels is raised. This will be used to cover the defect in skull base after tumour removal.
Fig.7 Bifrontal craniotomy is done with or without supraorbital rim.
Fig.8 Frontal lobe is retracted (white arrow) to expose the skull base. Yellow arrow – cribriform plate area. Green arrow – points at the tip of the saw blade cutting the skull base from below. Frontal sinus is cranialized.
Fig.9 Picture shows the defect in anterior skull base (yellow arrowheads). Green arrows (orbital roof).
Fig.10 Defect in the anterior skull base is reconstructed with pericranial flap. Picture taken from below showing pericranial flap (green arrow).
Fig.11 Post-op picture showing good cosmesis.
Fig.12 Post-op MRI shows the reconstructed skull base (yellow arrowheads).

The Heart Of Clinic

Dr. Rayappa

Dr. C. Rayappa MBBS, DLO, FRCS(Edin)

SENIOR CONSULTANT

+91 44 3315 1105

Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)

The Heart Of Clinic

Dr. Rayappa

Dr. C. Rayappa MBBS, DLO, FRCS(Edin)

SENIOR CONSULTANT

+91 44 3315 1105

Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)