The One-Piece Orbitozygomatic Approach: The MacCarty Burr Hole and the Inferior Orbital Fissure as Keys to Technique and Application

Aziz, Khaled; Froelich, Sébastien; Cohen, P. L.; Sanan, Abhay; Keller, Jeffrey T.; Loveren, Harry R. van

doi:10.1007/s701-002-8270-1

Cited by 82 publications

(49 citation statements)

References 28 publications

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“…During the orbitozygomatic osteotomy, the most inferior zone point was determined as the ZFF (Aziz et al, 2002;Gonzalez et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have suggested that the ZFF may be a useful anatomical landmark for the depth of facial dissection near the bone (Aziz et al, 2002;Gonzalez et al, 2002;Martins et al, 2003). The zygomatic nerve and its branches may be injured during facial surgery in the periorbital region (Mangal et al, 2004;Lei et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…The zygomaticofacial vessels may be disrupted by elevating periorbita from the lateral wall, and it is important that these vessels be identified and coagulated to prevent avulsion, bleeding and complications of postoperative hematomas. The existence and variations of the zygomaticofacial nerve, vessels, and foramina may affect the outcome of surgery (Aziz et al, 2002;Gonzalez et al, 2002;Williams, 2002;Mangal et al, 2004;Lei et al, 2006;Hwang et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

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Location and incidence of the zygomaticofacial foramen: An anatomic study

et al. 2009

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The location and incidence of the zygomaticofacial foramen (ZFF) was studied in 80 dry skulls (160 sides) of unsexed adult skulls of West Anatolian people. The average distances from the ZFF to the frontozygomatic suture, to the zygomaticomaxillary suture, and to the inferior orbital rim were found to be 26.2 +/- 3.2 mm, 18.6 +/- 3.14 mm, and 5.94 +/- 1.43 mm, respectively. The zygomas were evaluated for the number of foramina on their facial aspects. There was none in 25 (15.6%), one in 71 (44.4%), two in 45 (28.1%), three in 10 (6.3%), four in seven (4.4%), and five in two (1.3%) sides. The ZFF was also studied for its distribution around the zygoma by dividing the surface into four anatomical areas. There was no statistical difference between the morphometrical results on both sides. Data regarding the location and variation in the number of the ZFF is important in avoiding zygomatic nerve and vessel injury during surgery, but by virtue of the great variability found, ZFF is an unreliable landmark for maxillofacial surgery.

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“…During the orbitozygomatic osteotomy, the most inferior zone point was determined as the ZFF (Aziz et al, 2002;Gonzalez et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Location and incidence of the zygomaticofacial foramen: An anatomic study

et al. 2009

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“…To facilitate the one-piece technique, it is paramount to create a generous MacCarty bur hole that exposes 3 components: 1) frontal lobe dura, 2) orbital roof, and 3) periorbita). 3 The orbital rim is disarticulated with the frontotemporal bone flap as one piece using an osteotome and fracture technique. An orbital osteotomy is made just lateral to the supraorbital notch, inferior to the frontozygomatic suture, and across the orbital roof through the MacCarty bur hole.…”

Section: Modified One-piece Orbitozygomatic Approach: Technical Pearlmentioning

confidence: 99%

Microscopic versus endoscopic approaches for craniopharyngiomas: choosing the optimal surgical corridor for maximizing extent of resection and complication avoidance using a personalized, tailored approach

Liu

Sevak

Carmel

et al. 2016

FOC

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Resection remains the mainstay of treatment for craniopharyngiomas with the goal of radical resection, if safely possible, to minimize the rate of recurrence. Endoscopic endonasal and microscopic transcranial surgical approaches have both become standard methods for the treatment for craniopharyngiomas. However, the approach selection paradigm for craniopharyngiomas is still a point of discussion. Choosing the optimal surgical approach can play a significant role in maximizing the extent of resection and surgical outcome while minimizing the risks of potential complications. Craniopharyngiomas can present with a variety of different sizes, locations, and tumor consistencies, and each individual tumor has distinct features that favor one specific approach over another. The authors review standard cranial base techniques applied to craniopharyngioma surgery, using both the endoscopic endonasal approach and traditional open microsurgical approaches, and analyze factors involved in approach selection. They discuss their philosophy of approach selection based on the location and extent of the tumor on preoperative imaging as well as the advantages and limitations of each surgical corridor, and they describe the operative nuances of each technique, using a personalized, tailored approach to the individual patient with illustrative cases and videos.

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“…The 1-piece variant of the orbitozygomatic approach has been extensively studied. [2][3][4]10,17,19,21 One anatomical study on this approach found a decrease in the amount of orbital roof removed in the 1-piece variant, which limited the exposure to structures, working angles, and illumination. 21 Nevertheless, the 1-piece orbitozygomatic approach is routinely used at many centers.…”

Section: Discussionmentioning

confidence: 99%

The 1-piece transbasal approach: operative technique and anatomical study

Effendi¹,

Rao²,

Momin³

et al. 2014

JNS

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Object The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach. Methods Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma. Results Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm2 ± 360 mm2 vs 2045 mm2 ± 352 mm2, respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically. Conclusions The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.

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The One-Piece Orbitozygomatic Approach: The MacCarty Burr Hole and the Inferior Orbital Fissure as Keys to Technique and Application

Abstract: Understanding the MacCarty keyhole burr hole and the microsurgical anatomy of the inferior orbital fissure is essential to performing the FTOZ1 approach. The three types of FTOZ1 approach enable the surgeon to tailor the approach according to the surgical exposure needed for each lesion.

Cited by 82 publications

References 28 publications

Location and incidence of the zygomaticofacial foramen: An anatomic study

Location and incidence of the zygomaticofacial foramen: An anatomic study

Microscopic versus endoscopic approaches for craniopharyngiomas: choosing the optimal surgical corridor for maximizing extent of resection and complication avoidance using a personalized, tailored approach

The 1-piece transbasal approach: operative technique and anatomical study

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