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Skull Base Tumors: A Comprehensive Review of Transfacial Swing Osteotomy Approaches

Moreira-Gonzalez, Andrea M.D.; Pieper, Daniel R. M.D.; Cambra, Jorge Balaguer M.D.; Simman, Richard M.D.; Jackson, Ian T. M.D.

Plastic and Reconstructive Surgery: March 2005 - Volume 115 - Issue 3 - p 711-720
doi: 10.1097/01.PRS.0000152437.71574.4F
Original Articles: Pediatric/Craniofacial

Numerous techniques have been proposed for the resection of skull base tumors, each one unique with regard to the region exposed and degree of technical complexity. This study describes the use of transfacial swing osteotomies in accessing lesions located at various levels of the cranial base. Eight patients who underwent transfacial swings for exposure and resection of cranial base lesions between 1996 and 2002 were studied. The mandible was the choice when wide exposure of nasopharyngeal and midline skull base tumors was necessary, especially when they involved the infratemporal fossa. The midfacial swing osteotomy was an option when access to the entire clivus was necessary. An orbital swing approach was used to access large orbital tumors lying inferior to the optic nerve and posterior to the globe, a region that is often difficult to visualize. Gross total tumor excision was possible in all patients. Six patients achieved disease control and two had recurrences. The complications of cerebrospinal fluid leak, infection, hematoma, or cranial nerve damage did not occur. After surgery, some patients experienced temporary symptoms caused by local swelling. The aesthetic result was considered good. Transfacial swing osteotomies provide a wide exposure to tumors that occur in the central skull base area. Excellent knowledge of the detailed anatomy of this region is paramount to the success of this surgery. The team concept is essential; it is built around the craniofacial surgeon and an experienced skull base neurosurgeon.

Cleveland and Dayton, Ohio; Southfield, Mich.; and Valencia, Spain

From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation; Providence Hospital and Medical Center; Michigan Head and Spine Institute; Hospital Universitario “La Fe”; the Department of Surgery, Division of Plastic and Reconstructive Surgery, Wright State University School of Medicine; and the Institute for Craniofacial and Reconstructive Surgery, affiliated with Providence Hospital.

Received for publication March 25, 2003; revised March 24, 2004.

Presented at the 14th Annual Meeting of the North American Skull Base Society, in Memphis, Tennessee, February 22 to 25, 2003.

Ian T. Jackson, M.D., Institute for Craniofacial and Reconstructive Surgery, 16001 West Nine Mile Road, 3rd Floor, Fisher Center, Southfield, Mich. 48075, ianjackson@juno.com

©2005American Society of Plastic Surgeons