Transfacial Access Osteotomies to the Central and Anterolateral Skull Base

Abstract

The transfacial access osteotomies that are discussed in this chapter are not intended for use in treatment of malignant sinus neoplasms that have invaded the skull base. Such tumors require radical resections that frequently produce unavoidable disfigurement and dysfunction. Instead, these osteotomies are designed to maintain form and function of the facial skeleton and overlying soft tissues. They provide wider and more direct access to less aggressive tumors involving relatively inaccessible areas of the skull base itself or beyond to intracranial pathology while reducing or eliminating the need for traction on the brain, brainstem, or cranial nerves. These approaches must be thought of in terms of a surgical funnel, the mouth of which is located at the level of the superficial projections of the facial skeleton and the spout at the skull base. Although the spout size will be increased only slightly or not at all, the mouth of the standard transoral, transnasal, transfrontal, and transtemporal approaches to the skull base will be greatly widened. Thus the working distance from the surgeon’s hands to the skull base or intracranial target will be shortened, but the field view angle will be maintained or increased (Figure 45.1).