Le fort i osteotomy approach to the skull base

Sasaki, Clarence T.; Lowlicht, Roger A.; Astrachan, David I.; Friedman, Craig D.; Goodwin, W. Jarrard; Morales, Marco J.

doi:10.1288/00005537-199010000-00009

Cited by 62 publications

(20 citation statements)

References 9 publications

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“…88,96,100 A sublabial incision allows a horizontal osteotomy and down-fracture or inferior mobilization of the maxilla and hard palate to be performed. Others have described this approach as the "drop-down" maxillotomy approach.…”

Section: Le Fort I Osteotomy With Down-fracture Of Maxillamentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.

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Section: Le Fort I Osteotomy With Down-fracture Of Maxillamentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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“…72 The major transpalatal approach-related concerns are the development of a palatal fistula or wound dehiscence. 109 Lewark, et al, 72 performed Le Fort I osteotomies in 11 children and reported related complications including loss of unerupted tooth buds and epiphora in one case each. Disruption of facial growth was assumed to be unlikely because the osteotomy did not pass through growth centers.…”

Section: Neurosurg Focus / Volume 12 / May 2002mentioning

confidence: 99%

Tumors of the skull base in children: review of tumor types and management strategies

Tsai¹,

Santoreneos²,

Rutka³

2002

FOC

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Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.

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“…This can be reduced by utilising one of the anterior corridors of access (e.g. : transoral [13], transmaxillary [5,40,42], transsphenoidal, transantral and transmandibular [8,33]) and many of these techniques have been advocated in the management of basilar aneurysms and other central skull base lesions. However, in general these approaches are Intracranial target = basilar bifurcation.…”

Section: Minimise or Eliminate Brain Retractionmentioning

confidence: 99%

“…When utilised to gain access to high basilar bifurcation aneurysms the low anterolateral corridor of approach allows the surgeon to combine the advantages of the anterior approach of better visualisation of both P1 segments of the posterior cerebral arteries [5,42], with those of a lateral approach providing improved access to the vital posterior perforating arteries to the midbrain [16,17,38,39,41,56,58].…”

Section: Isolation and Protection Of Surrounding Neurovasculaturementioning

confidence: 99%

The orbitozygomatic infratemporal fossa approach: a quantitative anatomical study

et al. 1996

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Using detailed cadaveric dissections this study has demonstrated and quantified the increase in exposure and additional access gained by using the orbitozygomatic infratemporal fossa approach for neurosurgical access. The surgical window of exposure can be increased by up to 300% when this technique is utilised to facilitate access via either a subtemporal (to access the P2 segment of the posterior cerebral artery) or transsylvian (to access the basilar bifurcation) approach. In addition the distance between the surgeon and the operative field can be decreased by approximately 2-3 cm. The orbitozygomatic infratemporal fossa approach is a relatively simple technique which can readily increase neurosurgical exposure of the skull base. It also provides simultaneous access to the infratemporal fossa, pterygopalatine fossa and the orbit.

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Le fort i osteotomy approach to the skull base

Cited by 62 publications

References 9 publications

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Tumors of the skull base in children: review of tumor types and management strategies

The orbitozygomatic infratemporal fossa approach: a quantitative anatomical study

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