Download 1 FORMAL SYNOPSIS FORM Title:a Dismasking flap

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FORMAL SYNOPSIS FORM
Title:a Dismasking flap -a extended coronal flap- for approach of
craniofcial tumor and trauma; experience of 13 cases
Authors: Keisuke Imai, MD, Hiroyuki Komune, MD, Takeru Nomachi, MD, Takuya
Fujimoto, MD and Miki Fujii, MD
"Dismasking flap" is the cranio-orbito-facial degloving technique
employing circum-palpebral with or without piriform margin incisions and
presents a wide surgical fields under direct view1) (Fig-1,2). With the
use of dismasking flap it was possible to completely resect tumors of
the nasal cavity extending the orbit, the maxilla and the anterior cranial
base2). Dismasking flap is very useful for craniofacial tumor especially
for malignant tumor, severe complex fracture of craniofacial bone and
approach of the middle cranial base. This flap is retracted far way down
so that there is little traction on the facial nerve branches in the flap
and the middle cranial base comes into view with little compression on
the brain.
Since 1994, 13 patients have undergone Dismaking flap technique. The
indicated cases were multiple cranio-facial bone fracture (3 cases) and
malignant or premalignant craniofacial tumor (10 cases). The patients
ranged in age from 3 to 62 years. The period of postoperative follow-up
was from 2 to 7 years.
Operative procedure
After coronal flap is elevated, supraorbital neuro-vascular bundle is
isolated and cut. Then circum-palpebral blephaloplasty incision is placed
and dissection is carried out toward the orbital rim between the orbicularis
muscle and orbital septum, bilaminating the eyelid into anterior and
posterior layer. Medial canthual tendon is left intact, but cut secondarily
a little away from the insertion to the bone when entrance into the medial
orbital wall is indicated. The skin and the muscle of the lids belong
to the coronal flap, which is turned over well below to give direct exposure
of the periorbital structures. Infraorbital neurovascular bundle can be
isolated more than 10 mm in length, and when piriform margin is incised
half way down, the operative field become wider.
When infraorbital neurovascular bundle is cut and piriform margin is
totally incised, all the structures of the upper two-thirds of the face
except perigingival area of the maxilla come into direct view.
At the end of the operation infraorbital nerve, if severed, and
supraorbital nerve are anastomosed. Small triangular flap of the medial
canthal region is securely fastened to the medial canthal tendon by a
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FORMAL SYNOPSIS FORM
buried suture. Several buried sutures suspend periosteum corresponding
to the cheek pad with nylon strings to the periostium of the inferior
orbital rim.
results
There were no perioperative major complications. In minor temporary
complications, there were lagophthalmos (13 cases), blephaloptosis (4
cases) and sensory disturbance in superior orbital nerve area (13 cases),
but no permanent complication in all cases. In this paper, we report the
procedure of dismasking flap, its postoperative course and its
complication.
Fig-1
Fig-2
Fig-1: The design and schema of Dismasking flap
Fig-2: Intraoperative photograph
Reference
1) Tajima S, Tanaka Y, Imai K and et al.: Extended coronal flap- Dismasking
flap- for approach of craniofcial and skull base surgery. Bull. Osaka
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FORMAL SYNOPSIS FORM
Medical College 39:1-8, 1993.
2) Imai K, Tsujiguchi K, Toda C, Sung KC, and et al.: Osteoblastoma
of the nasal cavity invading the anterior skull base in a young child.
J.Neurosurg. 87:625-628, 1997.
3) Hirano N, Sasaki A, Watanabe T, Hori T, and et al.: Malignant fibrous
histiocytoma of the lateral wall of the orbit. Neurol Med Chir.
36:246-250, 1996.