Fronto-orbitozygomatic approach: functional and cosmetic outcomes in a series of 169 patients

Abstract

OBJECTIVE Advantages of the fronto-orbitozygomatic (FOZ) approach have been reported extensively in the literature; nevertheless, restoration of normal anatomy and the esthetic impact of surgery are increasingly important issues for patients and neurosurgeons. The aim of this study was to analyze functional and cosmetic outcomes in a series of 169 patients with different pathologies who underwent surgery in which the FOZ approach was used. METHODS Between January 2000 and December 2014, 250 consecutive patients underwent surgery with an FOZ approach as the primary surgical treatment. Follow-up data were available for only 169 patients; 103 (60.9%) of these patients were female and 66 (39.1%) were male, and their ages ranged from 6 to 77 years (mean 46.9 years; SD 15.6 years). Mean follow-up time was 66 months (range 6-179 months; SD 49.5 months). Evaluation of clinical outcomes was performed with a focus on 4 main issues: surgical complications, functional outcome, cosmetic outcome, and patient satisfaction. The additional time needed to perform orbitotomy and orbital reconstruction was also evaluated. RESULTS The permanent postoperative complications included forehead hypesthesia (41.4%) and dysesthesia (15.3%), frontal muscle weakness (10.3%), exophthalmos (1.4%), enophthalmos (4.1%), diplopia (6.6%; 2% were related to surgical approach), and persistent periorbital and eyelid swelling (3%). Approximately 90% of the patients reported subjectively that surgery did not affect their quality of life or complained of only minor problems that did not influence their quality of life significantly. The mean time needed for orbitotomy and orbital reconstruction was approximately half an hour. CONCLUSIONS Comprehensive knowledge of the potential complications and overall clinical outcomes of the FOZ approach can be of great utility to neurosurgeons in balancing the well-known benefits of the approach with potential additional morbidities.

Minimally Invasive Approaches to Anterior Skull Base Meningiomas

“…As neurosurgical techniques continue to evolve, secondary but important cosmetic outcomes have acquired an increasing focus in addition to surgical outcomes. 13,14 Therefore, an informed discussion with the patient is warranted, comparing the risks and benefits of each approach. In our series, we used the supraorbital approach in 20 patients with anterior skull base meningiomas.…”

The Subtemporal Approach to the Lateral Midbrain with and without Zygomatic Osteotomy: An Anatomical Study

“…It has to be noted that there can be negative cosmetic results related to the excessive mobilization of the temporal muscle, which is part of the transzygomatic subtemporal approach. In a series of 250 patients undergoing variations of the orbitozygomatic craniotomy, the following adverse cosmetic results have been noted: forehead hypesthesia in 41%, frontal weakness in 10%, and diplopia in 6% (Boari et al, ). Additionally, postoperative palsy of the frontal branches of the facial nerve can result in a poor cosmetic result.…”

Modified Orbitozygomatic Approach without Orbital Roof Removal for Middle Fossa Lesions

“…Orbitotomy and the zygomatic resection of conventional approaches is a technically demanding procedure that requires time for their correct execution and repair [ 8 , 17 , 24 ]. Boari et al [ 3 ] reported that the mean time required for orbitotomy and orbital reconstruction was about half an hour in a fronto-OBZ approach. The technique that we propose has the advantage that, by not removing the orbit, its reconstruction is not necessary, in that a thin bony plate is preserved to contain the eyeball and the periorbital soft tissues.…”

“…Pulsatile enophthalmos or the development of exophthalmos has been one of the most recurrent and significant complications associated with lateral and superior orbital wall removal from the OBZ approach [ 3 , 9 , 11 , 12 , 19 ]. Even in conventional approaches, it is argued that it is necessary to respect at least one-third of the orbital roof and to carry out an excellent anatomical reconstruction to avoid modifications in eyeball position [ 6 , 19 , 20 , 22 , 25 ].…”