The Extended Maxillotomy and Subtotal Maxillectomy for Excision of Skull Base Tumors

Abstract

An approach to tumors of the middle compartment of the skull base is described with three case reports. It is accomplished by extending the subtotal maxillectomy or maxillotomy to include removal of a part of the malar bone, coronoid process of the mandible, nasal turbinates, ethmoid and sphenoid sinuses, posterior nasal septum, and pterygoid plates. Extension of the incision through the anterior tonsillar pillar and lateral pharyngeal wall into the retropharyngeal space will assist to expose the craniocervical region from the sphenoid roof to the fifth cervical vertebra and the skull base between each eustachian tube and carotid canal. The function of the trigeminal, facial, and hypoglossal nerves, hearing, and nasal airway are preserved without mastoidectomy. A temporalis muscle flap closes the defect. Dysphagia and aspiration are not handicaps.

The utility of the temporalis muscle flap for oropharyngeal, base of tongue, and nasopharyngeal reconstruction

“…All flaps were mucosalized within 14 to 21 days, and similar findings have been reported by several authors in© the© past. 2,4,7,8,16,18 The overall minor complication rate of 30.8% is in keeping with other similar studies, once our minor complications are grouped into the categories noted above. 2-4,6,19© Two© of© our© patients© experienced© frontal branch palsies after flap elevation.…”

“…In our experience we have not found the need for split-thickness skin grafts to cover the intraoral surface. All flaps were mucosalized within 14 to 21 days, and similar findings have been reported by several authors in the past 2 , 4 , 7 , 8 , 16 , 18 …”

Surgical approaches and strategies for skull base chordomas

“…3,10 In addition to the LeFort I maxillotomy approach, the extended maxillotomy approach accompanied by a midline sagittal split of both maxilla and the soft palate facilitates access to the CCJ. 11,21,23 In our series, one patient in whom total resection was achieved via by the transmaxillary approach has enjoyed RFS for more than 7 years without any complications. As an alternative to the transmaxillary approach, it should be determined whether a combined transoral-transsphenoidal approach will be adequate.…”

New approach to the nasopharynx: The maxillary swing approach

“…The nasopharynx can be exposed adequately by extending a subtotal maxillectomy or maxillotomy, but in this case, the malar bone and the coronoid process of the mandible must be removed. 13 The maxillary swing approach to the nasopharynx as reported here overcomes these drawbacks. After the maxilla is swung laterally on the cheek flap, the whole nasopharynx is exposed.…”