title: The open-mouth fronto-orbitotemporozygomatic approach for extensive benign tumors with coexisting splanchnocranial and neurocranial involvement.
abstract: OBJECTIVE
  To describe the advantages of a modification of the standard fronto-orbitotemporozygomatic (FOTZ) approach, consisting of the forced opening of the patient's mouth (open-mouth FOTZ), for the treatment of benign tumors massively involving the splanchnocranium and neurocranium.
  
  
  METHODS
  The modified FOTZ approach obtained by forced mouth opening is described. Such a procedure was introduced with the aim of obtaining a minimally invasive access to lesions involving both the infratemporal-parapharyngeal spaces and the anteromedial cranial fossae. The forced opening of the mouth allows the surgeon to keep the coronoid process of the mandible away from the operating field, producing a wide exposure of the infratemporal space like that of the posterior wall of the maxillary sinus, which can be penetrated from behind without adding destructive procedures on the mandibular bone.
  
  
  RESULTS
  From a series of 45 patients affected by cranial base lesions operated on during an 8-year time period, three patients affected by juvenile nasopharyngeal angiofibromas were selected for an open-mouth FOTZ approach. In all cases, a complete eradication of both the intracranial and extracranial components of the tumor was possible by this approach. The same procedure was then used in four patients affected by extensive meningiomas and two patients harboring Vth cranial nerve schwannomas, with complete tumor removal.
  
  
  CONCLUSIONS
  In our experience, the open-mouth FOTZ approach seems particularly suited for extensive benign tumors (including juvenile nasopharyngeal angiofibromas) with splanchnocranial and neurocranial involvement. No indication exists for the use of this approach in malignant tumors, in which total eradication with large tumor-free margins is required.
authors.affiliation: Operative Unit of Neurosurgery, San Salvatore Hospital, Coppito, Italy. alessandro _di_rienzo@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Rienzo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ricci
authors.forename: Antonio
authors.initials: A
authors.lastname: Scogna
authors.forename: Donato
authors.initials: D
authors.lastname: Zotta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stati
authors.forename: Renato
authors.initials: R
authors.lastname: Galzio
authors.forename: Manfred
authors.initials: M
authors.lastname: Tschabitscher
mesh_terms: D000293:Adolescent; D018322:Angiofibroma / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery; D002648:Child; D005260:Female; D005624:Frontal Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000473:pathology / Q000601:surgery; D009303:Nasopharyngeal Neoplasms / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D012888:Skull Neoplasms / Q000601:surgery; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery*; D014420:Turbinates / Q000473:pathology / Q000601:surgery*