Choice of the Surgical Access for Malignant Tumors of the Central Zone of the Facial Skeleton

Abstract

This review describes the issue of surgical treatment for tumors in the middle third of the facial skeleton. Given the anatomical characteristics, clinical manifestations and social significance of this area, the operation should be as radical as possible, with minimal aesthetic and functional impairment in the postoperative period, in order to improve the oncological outcome and preserve the patient's quality of life. Surgical treatment is considered the "gold standard" for the treatment of sinonasal tumors, but the introduction of new methods of local control, such as intra-arterial chemoembolization, intra-operative radiation therapy and alternative radiation therapy sources and modalities, are more evidence and are helping surgeons to reduce the morbidity of surgical treatment while maintaining its radicality. The standard traumatic approaches through the medial line of the face are still used. While endoscopic access has its advantages and limitations, it is gaining popularity for the treatment of sinonasal tumors. If the primary tumor is spread over two or more anatomical compartments, endoscopic access is not applicable. Therefore, the "dismasking" bicoronal approach can be used to reduce morbidity in the visible facial area. The "dismasking" bicoronal access provides a large surgical field, helps to adequately assess the extent of the tumor and radically removes it with surrounding healthy tissue, while preserving the integrity of the facial skin, muscles and function of the facial and other cranial nerves and critical structures. To achieve better treatment results "dismasking" bicoronal access should be considered as an alternative to standard transfacial access and endoscopic method, taking into account the indications and limitations for each patient individually.