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A Versatile New Procedure for Wide Access to the Central Skull Base and Infratemporal Fossa

Peter J. Catalano, MD; Hugh F. Biller, MD

Arch Otolaryngol Head Neck Surg. 1993;119(4):394-400.

Abstract
• Extended osteoplastic maxillotomy provides wide, direct exposure of the lateral and/or central skull base. This procedure, developed in cadavers, has been used successfully in six patients. Briefly, the maxillofacial skeleton is partially exposed via a Weber-Fergusson incision. Osteotomies in the maxilla and zygoma completely disengage the maxilla from the facial skeleton. The maxilla is mobilized on the skin and soft tissues of the ipsilateral cheek, maintaining its vascularity. Medial positioning of the anterior osteotomy through the face of the maxilla determines the extent of exposure to the nasopharynx. The lateral osteotomy can be placed anteriorly at the malar eminence or posteriorly to include the glenoid fossa, thus determining the extent of exposure to the infratemporal fossa. Concurrent use of a pterional or temporal craniotomy provides corresponding access to the cranial cavity. Miniplate fixation of the maxilla and zygoma reestablishes skeletal contour. This new, versatile procedure can be used for benign and malignant lesions of the nasopharynx and infratemporal fossa, particularly in those patients requiring preoperative or postoperative adjuvant therapy.

(Arch Otolaryngol Head Neck Surg. 1993;119:394-400)

Author Affiliations
From the Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY.

Footnotes
Accepted for publication October 22, 1992.

Read before the Third Annual Meeting of the North American Skull Base Society, Acapulco, Mexico, February 18, 1992.

Reprint requests to Department of Otolaryngology, Box 1189, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029 (Dr Catalano).

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