ABSTRACT
Tumors of the pterygoid fossa are often regarded as unresectable because of their anatomic inaccessibility. The rapidly developing techniques of craniofacial surgery have advanced sufficiently to now allow safe ablative surgery in this area and yet preserve the functional status and cosmetic appearance of the patient. A technique utilizing a bicoronal incision that is extended to the angle of the mandible on the involved side is described. This allows wide exposure of the bony structures at the lateral base of the skull while maintaining the integrity of the facial nerve within the cutaneous flap. Temporary removal of the zygomatic arch achieves direct access to and visualization of the contents of the temporal and pterygoid fossae. Skull, mandibular, and maxillary bone adjacent to tumor can easily and safely be resected to obtain complete tumor-free margins. Craniectomy bone is harvested and split into inner and outer tables to reconstruct the bony defects. This approach was successfully utilized in a 5-year-old boy with a Group III rhabdomyosarcoma with residual tumor following combined chemo- and radiotherapy. He remains tumor-free at 15 months, postoperation. The technique can be adapted for a variety of mass lesions located at the anterior base of the skull, both intra- and extracranially. Morbidity and mortality should be minimal with an experienced craniofacial team.
Subject(s)
Facial Bones/surgery , Head and Neck Neoplasms/surgery , Rhabdomyosarcoma/surgery , Surgical Flaps , Child, Preschool , Facial Nerve/surgery , Follow-Up Studies , Head and Neck Neoplasms/diagnostic imaging , Humans , Male , Pterygoid Muscles/surgery , Rhabdomyosarcoma/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Thirty-three consecutive patients with metopic synostosis treated between January of 1980 and June of 1984 are presented. All patients underwent craniofacial reconstruction by an interdisciplinary team utilizing a detailed remodeling of the supraorbital rims and forehead. Advantages of the current modifications are discussed, as well as an analysis of the results. We believe this represents a significant advance over previous methods not only because of the superior cosmetic results achieved, but also because of its safety and reproducibility. Reoperation rate was less than 10 percent overall and was necessary only in patients with complex cranial vault abnormalities. Mean follow-up was 22.8 months, with no deaths, infections, or damage to visual or cerebral function. Postoperative head circumference demonstrated an immediate increase followed by a normal growth curve.
Subject(s)
Craniosynostoses/surgery , Child , Child, Preschool , Craniosynostoses/diagnostic imaging , Female , Follow-Up Studies , Humans , Infant , Male , Methods , Radiography , Skull/diagnostic imaging , Skull/surgerySubject(s)
Cerebral Ventricles/abnormalities , Fetal Diseases/diagnosis , Hydrocephalus/diagnosis , Abnormalities, Multiple/diagnosis , Cerebral Ventricles/surgery , Cerebrospinal Fluid Shunts , Female , Fetal Diseases/surgery , Gestational Age , Humans , Hydrocephalus/surgery , Infant, Newborn , Pregnancy , Prenatal DiagnosisABSTRACT
Untreated fetal hydrocephalus results in gross cranial and facial abnormalities and profound brain damage. In an attempt to prevent both, a ventriculoamniotic shunt was implanted in a fetus with probable X-linked aqueductal stenosis and hydrocephalus. Performed at 24 weeks' gestation, the procedure used techniques similar to those used for intrauterine transfusion. After shunt placement, the fetal head size grew normally until after the 32d week, when the shunt failed. A cesarean delivery was performed at 34 weeks' gestation. The infant received a standard ventriculoperitoneal shunt after delivery, and his neonatal course has been evaluated through the first three months of life. In selected cases, the ventriculoamniotic shunt may be an acceptable treatment for fetal hydrocephalus.
