Netting operation to control neurofibroma of the face

When neurofibroma involves the face, it can lead to a most disfiguring, destructive, and debilitating condition. Because of the unique aesthetic and functional properties of the face, the surgeon might hesitate to remove all of the involved soft tissues and facial nerves in a radical procedure. Involvement of the craniofacial skeleton makes the treatment more difficult and complex. The treatment usually consists of excising the symptomatic lesion, and often these lesions are incompletely corrected. Regrowth after partial excision is frequent and leads to recurrence of deformity. The force of gravity plays a major role in the appearance of deformity, leading to facial tissue drooping and bulging as the mass grows and gains weight. The aim of this operation was to contain the residual mass after excision within a tight net against the force of gravity, thus limiting and preventing drooping or bulging of the facial soft tissue while preserving muscles and nerves associated with facial expression. Polytetrafluoroethylene (Teflon) mesh, used as a net, was evaluated as a replacement material for subcutaneous tissue and a substitute for superficial fascia destroyed by tumor infiltration. The mesh was suspended in the superior-posterior direction, capturing the residual mass like a net capturing fish. From 1989 to 1999, a total of eight patients underwent the netting procedure after partial excision of neurofibroma of the face. The follow-up period was 3 to 10 years. The use of Teflon mesh proved to be compatible with the surrounding tissue, endurable at follow-up, and consistent with expectations. Follow-up computed tomographic scans revealed no further visible tumor growth, and the area was contained under the mesh net with satisfactory postoperative facial contour. The advantages of this procedure are the avoidance of radical excision of facial soft tissue, preservation of remnant facial expression, and prevention of progression of facial dysmorphism.