Craniofacial approaches to sinus malignancy.

Craniofacial approaches to sinonasal malignancies that abut or penetrate the skull base allow isolation of tumor from its vascular supply, identification and preservation of neurovascular structures adjacent to tumor, and en bloc resection with meaningful margins. The transfacial access, and the adjuncts of lateral facial split and mandibular swing, have been presented. An extended frontal craniotomy, which encompasses the superior orbital rims, affords exposure of the nasal, sinus, orbital, and intracranial components of a dissection in one surgical field. The skull base team approach yields a high cure rate for aggressive but benign skull base neoplasms, such as meningiomas, and when combined with external beam irradiation the only nonpalliative regimen for sinonasal malignancies that penetrate the anterior or middle fossa.