Specialities » Head and Neck Tumour Surgery » Cancer of Paranasal Sinus » 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. 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)

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The Heart Of Clinic

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)

Mithun Das

03:35 18 Mar 23

Its a pleasure experience with Dr. Rayappa C. We came for my wife thyroid nodules operation and testing for cancer malignancy. Doctor taken care everything with my previous diagnosis report and suggest to surgery half of thyroid infected lob.After this operation we got biopsy report that indicate still cancer not affected.Thanks to doctor and wishes him all the very best.

Saima Hasin

07:07 13 Mar 23

A sincere and dedicated doctor. He treated my husband for Oral Cancer. He gave his best efforts to overcome the disease. With patience and sincerity he handled the post surgery stages. We are so thankful to him. Expressing our gratitude to Almighty Allah and of course to Dr.Rayappa for his recovery .

Reyad Alam

16:49 16 Feb 23

Just saying ‘Thank you’ will not justify what Dr. Rayappa sir has done for us.My mom was having difficulty in breathing for merely 2 years due to thyroid enlargement.So we consulted Dr.Rayappa and he asked us to do surgery as soon as possible. It was hard for us to take the decision since a lot of risks was involved but we went ahead with it.Post surgery - My mom feels so energetic and alive, which she never felt before. Can breathe better, can talk, and just recovered in 2 days. The surgery was a success and Dr. Rayappa and his team took great for us throughout. We can’t describe the joy and happiness we’re filled with to see my mother so healthy.We give our heartfelt gratitude to Dr.Rayappa sir and his team.Dr. Rayappa is a great Otolaryngologist and we highly recommend him.

Poojha Shri

15:49 06 Feb 23

This is Vanamadevi patient of Dr.Rayappa. Dr sir is a God in the form of human. Highly blessed to be treated by him.Gave us hope in a hopeless situation. Very good service by the whole team. Thank you.

Rajiya Sultana

08:47 06 Jan 23

I am very much satisfied in your treatment. Dr.Rayappa sir is a very kind hearted man and a great doctors ever seen in my life.May Allah bless him and his family.

Craniofacial Resection