Maxillary Swing Approach for Resection of Central Skull Base Pathologies: Results and Limitations

Abstract

Introduction: The central skull base is located in the center of the head and is more than 10 cm from the surface from all directions; thus, it is a challenge for the surgeon to gain adequate exposure for eradicating pathologies in the region. Superior and posterior approaches are obstructed by the brain and the spinal cord, and the palate and the mandible limit exposure of the region from the inferior aspect. The infratemporal fossa approach from the lateral side could reach the central skull base, but a number of vital structures, such as the facial nerve and the internal carotid artery, have to be mobilized and displaced. Some functional deficits might result from this approach. The anterior approaches, such as the extended Le Fort I and the midfacial degloving procedures, allow visualization of the lesion at the central skull base, but access over the superior and lateral aspects are limited. The anterolateral approach toward the central skull base provides a wide exposure of the region for a radical resection of the whole range of pathologies in the region. Through a Weber-Ferguson incision, the maxillary antrum below the inferior orbital floor could be swung laterally while remaining attached to the anterior cheek flap.