Midline anterior craniofacial approach for malignancy: Results of en bloc versus piecemeal resections

Thirty consecutive cases of midline anterior craniofacial procedures for th e treatment of malignant neoplasms arising from the paranasal sinuses were reviewed. Posterior and lateral base craniofacial procedures were specifica lly excluded. This review compares the results, in terms of survival and ma jor complication rate, between en bloc and piecemeal resections. The averag e follow-up was 4 years and 3 months. Sixteen patients were treated with an en bloc resection. The major complication rate was 31%. One-year survival rate was 94% for the en bloc resection group, 67% for patients wit positive margins, and 100% for patients with clear margins. Three-year survival for en bloc resection dropped to 56, 33, and 67%, respectively. Fourteen patie nts were treated with piecemeal resections. The major complication rate was 21%. One-year survival rate was 83% for the piecemeal resection group, 60% for patients wit positive margins, and 100% for patients with clear margin s. Three-year survival dropped to 70, 60, and 80%, respectively. Although i t is considered desirable to obtain an en bloc resection in some craniofaci al procedures, we conclude that a piecemeal resection is a viable alternati ve in situations where an en bloc procedure is difficult to obtain safely.