Degloving transfacial approach with Le Fort I and nasomaxillary osteotomies: alternative transfacial approach.

Objective: We present surgical results obtained with the use of an alternative transfacial approach to the central cranial base.

Methods: A degloving transfacial approach, which is a combination of the midface degloving procedure, the Le Fort I osteotomy with a pediculated cartilaginous septum, and a nasomaxillary osteotomy, was used in 13 procedures for 8 patients. The lower clivus and upper cervical spine were approached via a submucosal route, without opening of the oropharyngeal mucosa. The wall of the nasopharynx was closed with the mucosa of the bony septum. Several patients had previously undergone other surgical procedures and received radiotherapy.

Results: The follow-up periods ranged from 4 months to 6.4 years. The same procedure was repeated three times for one patient, with intervals of 5.5 and 1.5 months, and twice for three patients, with intervals of 8.2, 6.3, and 1.3 years. A maxillary antrotomy or bifrontal craniotomy with removal of the orbital bar was combined with this technique. No significant or insurmountable technical problems were encountered, even among patients who had undergone previous surgery or radiotherapy.

Conclusion: Our technique is relatively simple, with good cosmetic results, and affords sufficient access to the central cranial base from the frontal base down to the upper cervical spine, especially for epidural lesions located in the midline between the carotid arteries. It offers much lower risks of damage to vital neurovascular structures, as well as of meningeal or pharyngeal infectious problems, wound dehiscence, and cerebrospinal fluid leakage. This procedure can be repeated without any increase in difficulty.