[Enlarged transfacial approach in the surgery of tumors of the ethmoid].

Cancers and tumours of the ethmoid bone are characterized by the possibility of extension towards the lamina cribrosa and within the cranium. Removal via a combined neurosurgical and paralateronasal route would appear to provide a more favourable prognosis for the patient. It is, however, a particularly cumbersome approach, and the neurosurgical follow up may be difficult. This is why we recommend a direct approach to both the ethmoid bone and the anterior part of the base of the cranium via a transfacial route, thus permitting complete removal of the tumour and of any intracranial extension through the lamina cribrosa. A number of points of technique are important: the line of the skin incision and the flap of cranial periosteum, operative examination and exploration of the upper part of the tumour, the reconstruction of the meningeal barrier and, if necessary the base of the cranium. The price to be paid for this approach route is the scar which is, however, always of minimum size and well tolerated by patients. Operative follow up is simple--which is the major advantage of the technique--and the carcinological prognosis appears to be as satisfactory as for the combined route.