Facial Traanslocation Approach case-1

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

Transfacial Approaches - Facial Translocation Approach

Case-1

A 51 year old male was diagnosed to have low grade sarcoma of nasopharynx extending into
the sphenoid sinus, parasellar region, pterygoid plates and muscles. The tumour was removed through a facial translocation approach of Janecka. At 18 months follow up no local tumour recurrence was noted.


CT shows tumour in the nasopharynx extending into the sphenoid sinuses, para sellar region and invading the pterygoid plates and muscles.		MRI shows tumour in the nasopharynx extending into the sphenoid sinuses, para sellar region and invading the pterygoid plates and muscles.

The lateral rhinotomy incision is extended laterally through the lower fornix of conjunctiva to preserve the facial nerve supplying orbicularis oculi. Then extended superiorly as a hemicoronal incision.		Superior and inferior skin flaps were raised exposing the bone to be removed temporarily.

Orbito-zygomatico-maxillary bone flap was temporarily removed for access. Probe is in the infra orbital foramen.		Temporalis is reflected down. Drilling continued along the greater wing of sphenoid towards the sphenoid sinus. The contents of sphenoid, its anterior wall and floor, left pterygoid plates, cartilaginous portion of eustachian tube and contents of left infra temporal fossa were excised.

Temporalis muscle is rotated into fill the defect. Orbito-zygomatico-maxillary segment of bone was plated. The divided lower canaliculus was intubated.		After closure of skin incision, temporary tarsorrhaphy and intubation of the nasolacrimal apparatus has been done.

Postoperative axial CT shows complete tumour removal and the temporalis muscle is seen filling the defect.		Postoperative coronal CT shows complete tumour removal and the temporalis muscle is seen filling the defect.
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