Craniofacial resection for paranasal sinus cancer with free flap repair.

A combined transcranial and facial approach is recommended for antroethmoidal cancers which have invaded the cribriform plate area. This permits a complete enbloc excision of the ethmoid labyrinths. In most patients orbital exenteration was necessary because of tumour invasion. In the facial approach adequate exposure is achieved by mobilizing the entire nasal complex which is swung to the contralateral side. The surgical defect is repaired with a revascularized tensor fascia lata muscle and skin flap. The flap is tailored to support the cranial contents, provide muscle bulk for the orbitomaxillectomy cavity and skin for the face, nasal and palatal surfaces. Postoperative complications are few and most patients received their planned postoperative radiotherapy within a few weeks of the surgery. Since 1980, nine patients have been treated and six of these remain alive and free of disease.