LeFort I osteotomy approach to the anterior skull base

Abstract

Anterior skull base neoplasms require a multispecialty approach for adequate resection and reconstruction. Otolaryngologists are often consulted to help provide access to middle cranial fossa tumors or treat anterior cranial base pathology that arises from the nasal cavity or paranasal sinuses. The LeFort I osteotomy with downfracture of the maxilla is one of many well-described osteoplastic anterior transfacial approaches to access these areas of the skull base. The approach greatly improves visualization of not only the central skull base, but also the infratemporal fossa when the posterior wall of the antrum and the pterygoid plates are removed. We will review proper patient selection, the anatomy, and surgical exposure with modifications of the LeFort I osteotomy, operative procedure, and complications. This approach should be included in the skull base surgeon's repertoire as an intermediate alternative to limited access transnasal, transantral, and endoscopic approaches and wide exposure face-splitting procedures.