October 31, 2011

‘Scarless’ surgery takes out tumors through natural skull opening

Area above jawbone, below cheekbone, proves handy new route to skull base

A technique developed by Johns Hopkins surgeons is providing a new route to get to and remove tumors buried at the base of the skull: through the natural hole behind the molars, above the jawbone and beneath the cheekbone.

In a report detailing the novel surgery, published in the October issue of The Laryngoscope, the surgeons say that the procedure, already performed in seven patients, yields faster recovery and fewer complications than traditional approaches. And, because the incisions are made inside the cheek, there are no visible scars.

Kofi Boahene, an assistant professor of facial plastic and reconstructive surgery and of otolaryngology–head and neck surgery at the Johns Hopkins University School of Medicine, says that the idea for the new approach came to him when a 20-year-old female patient previously treated for a brain tumor developed a new tumor deep in the skull base.

Traditional surgeries to remove skull-base tumors require incisions through the face and also bone removal, which can sometimes be disfiguring. Additionally, these operations can harm facial nerves, leading to paralysis that affects facial expressions, and require days or weeks of hospitalization and recovery. Boahene said he was gazing at a skull model in his office, considering options to spare his patient from another traditional surgery. “I looked at the ‘window’ that already exists in the skull, above the jawbone and below the cheekbone, and realized this was an access route not previously recognized for this kind of surgery,” he said.

Knowing there was always the option of switching to the traditional approach while trying the new one, Boahene and his colleagues performed the new procedure on his patient last year. The expected surgery time shrank from six hours to two. Additionally, the patient was able to leave the hospital the next day and return to college, with no visible evidence that she had had surgery.

The report in The Laryngoscope describes details of the surgeries on three of the seven patients Boahene and his colleagues have thus far treated with the new technique. Besides benefits for patients, he and his colleagues note, the new procedure is significantly less complicated for surgeons to perform, provides excellent visualization of the skull-base area and could potentially save health care dollars, due to patients’ shorter hospital stays.

Not all patients are candidates for this procedure, Boahene cautioned. It isn’t an option for those with very large skull-base tumors or for those with tumors that wrap around blood vessels. For these patients, traditional skull-base surgery is still the best choice, he said.

In the future, he and his colleagues plan to try the new procedure using a surgical robot, which could provide even better visualization for surgeons and further reduce chances of complications for patients.


Related websites

Kofi Boahene

Otolaryngology–Head and Neck Surgery at Johns Hopkins