Therapy of Tumors Affecting the Paranasal Sinuses and Sellar Region

Abstract

Due to the close topographic relationship between maxillary sinuses, paranasal sinuses, and skull base the therapy of tumors affecting these regions often requires an interdisciplinary, joint surgical procedure by maxillofacial surgeons, ENT surgeons, and neurosurgeons (Riediger and Jahnke 1988). From the maxillofacial surgeons’ point of view this is especially true in neoplasms expanding after destructive growth from the maxilla via the maxillary sinus towards the orbit and skull base. Surgical concepts are determined, especially regarding the degree of radicality, by the technical possibility of defect closure and avoidance of liquor fistulas. In extensive resections in the midface region, including maxillary segments, special attention must be paid to functional masticatory rehabilitation. Whereas minor defects can often be cared for according to the principles of local grafting, extensive defects including parts of the maxilla require distant grafts. Pedicled myocutaneous grafts and especially microsurgical techniques have decisively contributed to the scope of modern free tissue transfer (Watson et al. 1979; Riediger and Schmelzle 1986). Their employment provides us with means for secure coverage of the skull base as well as a bony midface reconstruction resembling the normal anatomical structures as much as possible, especially inmaxillary segments carrying masticatory functions.