Approaches to Skull Base
I Anterior Cranial Base
  Anterior craniofacial resection
Basal subfrontal approach
II Middle Cranial Base

Central Compartment  

  Trans septal sphenoid
Transpalatal
Extended maxillotomy
Midfacial split		  

Lateral Compartment  

  Infratemporal fossa approach l case 1 l case 2
Transparotid
Subtemporal preauricular infratemporal fossa approach
Trans facial approaches

  Facial translocation approach l case 1 l case 2
Extended osteoplastic maxillotomy approach
Extended transfacial subcranial approach l case 1 l case 2
III Posterior cranial base

Transtemporal approaches
  Translabyrinthine approach
Transotic approach
Transcochlear approach l Case 1 l Case 2

Extreme lateral/transcondylar approach

 
Skull Base Surgery

Extended Transfacial Subcranial Approach

 

A 65 year old male had recurrent bleeding from the right nostril with nasal obstruction. He also had numbness over midface, difficulty in opening the mouth and right facial pain. He was diagnosed to have
squamous cell carcinoma of the right maxilla extending into the orbit and infratemporal fossa and infiltrating the temporalis and pterygoid muscles. He had preoperative radiotherapy (50GY) followed by en-bloc
resection using an extended transfacial subcranial approach. The temporalis muscle was divided 2 cms above the zygomatic arch. The skull base (greater wing of sphenoid) was drilled and thinned out after raising the pterygoid muscles subperiosteally. Both pterygoid plates were divided near their attachment. Total
maxillectomy and orbital exenteration carried out and the specimen including ascending ramus of the mandible and the contents of the infratemporal fossa removed en-bloc.

 

 

MRI shows the tumour filling the right maxillary antrum extending into right orbit and infratemporal fossa and infiltrating the pterygoid and temporalis muscles.

 

   MRI shows the tumour filling the right maxillary antrum extending into right orbit and infratemporal fossa and infiltrating the pterygoid and temporalis muscles.
 

After reflection of skin flaps, mandible was divided at its angle.

 

   After en-bloc removal of the tumour. Arrow points greater wing of sphenoid.
 

Postoperative CT shows no residual tumour. Rectus muscles flap is seen filling the operated area.

 

   Postoperative CT shows no residual tumour. Rectus muscle flap is seen filling the operated area.
 

Postoperative photograph shows acceptable cosmesis.

 

  

Postoperative intraoral photograph shows the
rectus muscle flap filling the palatal defect.

 

go to Case-2