A new modification of the transoral route involving a Le Fort I maxillotomy has been developed to offer much-improved exposure of the midline skull base. The procedure involves a standard Le Fort I osteotomy combined with division of the nasal septum and lateral pterygoid laminae, and excision of the inferior turbinates and vomer. With insertion of a modified Dingman gag, exposure is gained from the pituitary fossa to the arch of the atlas. The approach has been successfully employed to resect eight different skull base lesions, both intracranially and extracranially, in 20 operations involving 17 patients. Complications and morbidity were minimal. Postoperative cosmetic results and occlusion were excellent. The Le Fort I maxillotomy approach has distinct advantages in dealing with a whole spectrum of pathology around the clivus and postnasal space.
Adolescent Adult