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This case report discusses a joint subciliary and facial degloving approach in excising a large rare facial fibroblastic type tumour in a 2-year-old child. Photographic documentation of the operation was recorded.

A 2-year-old girl presented with 3-month history with a rapidly progressive left sided facial lesion centred around the lateral nasal wall and medial canthus extending to her midface and infero-medial orbit. The child had developed sleep apnoea due to the mass-effect. After imaging, the lesion was biopsied by ENT.

MRI imaging showed a well-defined lesion 47x45x33mm involving the anterior maxilla, infero-medial orbit, extending into the nasal cavity, deviating the septum and protruding through the nostril. Review of the biopsy suggested a fibromyxoid tumour or a primitive myxoid mesenchymal tumour of infancy. MDT recommended surgical excision.

Joint ENT and ophthalmic surgery was undertaken using a mid-facial degloving technique through a gingivobuccal incision, oculoplastics carried out a sub-ciliary approach which allowed good access to the large tumour. Stanmore histopathology review showed a primitive myxoid fibroblastic type tumour which was difficult to classify with no evidence of malignancy.

This is a case of a very rare rapidly growing tumour in a child causing significant respiratory issues and disfigurement. The Multidisciplinary approach allowed excellent access to remove this tumour. It also highlights the importance of multidisciplinary discussion and planning.