Surgical management of carcinomas at the inner canthus is based on three criteria which are listed in a descending order of importance: tumor resectability with adequate margins, preservation of vision, and acceptable cosmetic result. The lesions resected are to create trapezoid or rectangular defects which can be closed simply with primary closures or with Z- or W-plasties. In medium sized defects skin is borrowed from the glabella, upper nasal dorsum, or nasolabial sulci and used as rotational flaps. In more extensive lesions, through and through defects, or when lined flaps are required, nondelayed midline forehead pedicled or island flaps are employed. For very large defects, sliding cheek flaps, sickle forehead flaps, horizontal forehead flaps, and (in rare instances) scalping flaps where the distal segment is the temporal, hairless skin is used. Tumors which extend intracranially and are deemed resectable are removed with a combined intracranial approach. The latter may be via a transfrontal sinus resection or a combined lateral rhinotomy and frontal craniotomy resection. Regional lymph node metastasis normally requires a superficial parotidectomy, radical neck dissection (including submaxillary, angular, and mandibular nodes), and occasionally postauricular lymph node dissection. Distant metastases are contraindications for major surgical procedures.
