Between 1996 and 1999, we used the Le Fort I maxillotomy technique to operate on seven patients, aged 28 to 79 years, who had lesions of the anterior skull base (table).
Access to the central skull base via a modified Le Fort I maxillotomy: The palatal hinge flap.
This infiltrative tumor located at the skull base has the potential to metastasize and recur, thus meeting the characteristics of a malignant tumor. The maxillotomy, as well as a number of other surgical approaches to the clivus, has been developed and refined for removal of this formidable tumor.
One such surgical technique, the maxillotomy, is presented via a case report, integrating pathology, anatomy, clinical presentation and surgical technique.
Advocates of the maxillotomy approach argue that it provides wide exposure of the clivus with reduced mortality.
A combined extended maxillotomy was recommended by the neurosurgeon.
TH underwent a left extended maxillotomy for gross total removal of a large complex chordoma on October 17, 1995.
After the exposure to the clivus had been made via maxillotomy, the neurosurgeon entered the procedure.
A consensus reported in the neurosurgical literature is that the patient with a previously operated clival chordoma followed by radiation therapy is far more at risk of developing a postoperative CSF leak than a patient with a "virgin" chordoma.[2,3] In the performance of a maxillotomy for a clival lesion, the maintenance of dural integrity may involve primary suture, free fascia lata graft or transposition of the temporalis muscle followed by possible placement of a lumbar drain. Should a CSF leak occur, the patient is at risk for the development of meningitis.
Most patients experience various degrees of sensory impairment of the face ipsilateral to the maxillotomy, resulting predominantly from manipulation of the infraorbital nerve and occasionally the mandibular division of the trigeminal nerve within the infratemporal fossa. Anesthesia of the palate is related directly to surgical trauma, which typically resolves over 3-6 months following surgery.