title: A surgical modification for performing orbitozygomatic osteotomies: technical note.
abstract: The addition of orbitozygomatic osteotomies to the fronto-temporo-sphenoidal craniotomy minimizes brain retraction required to reach deep seated pathology by allowing additional soft tissue dissection and strategic cranial bone removal. We report a modification of this technique in order to reduce soft tissue and cosmetic morbidity while increasing the efficiency with which this technique is performed. A two piece fronto-temporo-sphenoidal craniotomy combined with orbitozygomatic osteotomies was analyzed via cadaver dissection. The craniotomy and orbitozygomatic osteotomies were performed using the foot plate of the craniotome to facilitate the orbitozygomatic osteotomies. A similar technique was utilized in the operating room to safely create the two piece fronto-temporo-sphenoidal craniotomy and orbitozygomatic osteotomies in a series of patients. The illustrated technique was performed in cadavers and the results were analyzed in a series of 18 consecutive patients with minimum 3-month follow-up. Increased efficiency, good tissue preservation, and minimal soft tissue damage with no orbital injury were noted with a high rate of gross total lesional resection. With the added safety of a cutting instrument separated from the orbital soft tissues by a footplate, tissue trauma was minimized. Orbitozygomatic osteotomies are frequently added to the fronto-temporo-sphenoidal craniotomy in order to reach intracranial pathology that would previously have required excessive brain retraction to address. This manuscript details the use of a single drill system that can be used for both the craniotomy and the safe and efficient generation of orbitozygomatic osteotomies.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Conway
authors.forename: Shaan M
authors.initials: SM
authors.lastname: Raza
authors.forename: Khan
authors.initials: K
authors.lastname: Li
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D003399:Craniotomy; D005260:Female; D005626:Frontal Sinus / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D009918:Orbital Neoplasms / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures; D013525:Surgical Instruments; D015050:Zygoma / Q000601:surgery*