Craniofacial resection and reconstruction of an ethmoid melanoma invading cranium

The application of craniofacial techniques has allowed the excision of lesions heretofore thought unresectable. Extensive exposure is gained through the use of bicoronal and face-splitting incisions and by the performance of facial osteotomies. Dural defects are reconstructed with autogenous tissue, preferably with local flaps of dura or pericranium. The communication between the extradural space and the nasal cavity is similarly closed. Pericranial flaps based anteriorly on the supratrochlear and supraorbital vessels or laterally based flaps utilizing pericranium and temporalis muscle and fascia are well vascularized and can reach the defect. Osseous reconstruction of the anterior cranial floor, nasofrontal area, and other areas is most easily done at the time of resection using cranial bone and rigid mini-plate fixation. A case illustrating these techniques is presented.