title: Skull base tumors: a kaleidoscope of challenge.
abstract: Resection of skull base lesions has always been riddled with problems like inadequate access, proximity to major vessels, dural tears, cranial nerve damage, and infection. Understanding the modular concept of the facial skeleton has led to the development of transfacial swing osteotomies that facilitates resection in a difficult area with minimal morbidity and excellent cosmetic results. In spite of the current trend toward endonasal endoscopic management of skull base tumors, our series presents nine cases of diverse extensive skull base lesions, 33% of which were recurrent. These cases were approached through different transfacial swing osteotomies through the mandible, a midfacial swing, or a zygomaticotemporal osteotomy as dictated by the three-dimensional spatial location of the lesion, and its extent and proximity to vital structures. Access osteotomies ensured complete removal and good results through the most direct and safe route and good vascular control. This reiterated the fact that transfacial approaches still hold a special place in the management of extensive skull base lesions.
authors.affiliation: Department of Oral & Maxillofacial Surgery, MGM Dental College & Hospital, Navi Mumbai, Maharashtra, India.
authors.forename: J N
authors.initials: JN
authors.lastname: Khanna
authors.affiliation: Department of Oral & Maxillofacial Surgery, MGM Dental College & Hospital, Navi Mumbai, Maharashtra, India.
authors.forename: Srivalli
authors.initials: S
authors.lastname: Natrajan
authors.affiliation: Department of Oral & Maxillofacial Surgery, MGM Dental College & Hospital, Navi Mumbai, Maharashtra, India.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Galinde
keywords: skull base lesions; transfacial access osteotomies; transfacial swing approaches
references.citation: J Oral Maxillofac Surg. 1998 Feb;56(2):272-6
references.pmid: 9461160
references.citation: Int J Oral Maxillofac Surg. 1991 Oct;20(5):291-5
references.pmid: 1761882
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Jun;103(6):e23-9
references.pmid: 17449289
references.citation: Oral Maxillofac Surg Clin North Am. 2003 Aug;15(3):429-46
references.pmid: 18088694
references.citation: J Neurosurg. 1993 Apr;78(4):673-81
references.pmid: 8450345
references.citation: Radiology. 1990 Jul;176(1):263-5
references.pmid: 2162070
references.citation: Br J Oral Maxillofac Surg. 1991 Aug;29(4):230-6
references.pmid: 1655014
references.citation: J Surg Oncol. 1985 Jan;28(1):21-8
references.pmid: 2982059
references.citation: Cancer. 1982 Feb 1;49(3):562-72
references.pmid: 6277451
references.citation: Int J Oral Maxillofac Surg. 1991 Oct;20(5):285-90
references.pmid: 1761881
references.citation: Neurosurgery. 1998 Dec;43(6):1398-407; discussion 1407-8
references.pmid: 9848854
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jan;89(1):9-11
references.pmid: 10630934
references.citation: Plast Reconstr Surg. 2005 Mar;115(3):711-20
references.pmid: 15731668
references.citation: Otolaryngol Clin North Am. 2001 Dec;34(6):1025-42, vii
references.pmid: 11728930
references.citation: Atlas Oral Maxillofac Surg Clin North Am. 2010 Sep;18(2):151-60
references.pmid: 21036316
references.citation: J Oral Maxillofac Surg. 1995 Apr;53(4):473-6
references.pmid: 7699508
references.citation: J Maxillofac Surg. 1986 Jun;14(3):119-22
references.pmid: 3522784