The Transoral-Transmaxillary Approach to the Skull Base

The indications, technique, and results of the transoral-transmaxillary approach to the skull base are described. The median approach via the palate, velum, or following a Le Fort I osteotomy allows us to access pathological structures (e.g., fractures, infections, tumors, malformations) of the upper anterior cervical spinal column, the clivus, the sphenoidal sinus, and the orbits' apex. In comparison, using the approach described by Raveh, a vast area of the cranial base can be scrutinized, although the manual manipulation, bone transplantation, and the osteosynthesis in the craniocervical border via the transoral-transpalatine approach proves easier, more direct, and gives greater visual control of the entire operating field. Additionally, the transoral approach can be combined with an extraoral approach, rendering a vast region of the skull base exposed for surgical manipulation. If access to regions of the lateral skull base is necessary, the buccal-transpalatine approach can be succesfully implemented allowing not only access to the skull base but also vast regions of the visceral cranium. With the advent of innovations like navigation systems, a higher degree of surgical orientation as well as accuracy can be achieved, this being beneficial to the surgeon and patient alike.

In this paper, we feature the transoral-transmaxillary approach solely as well as in combination with extraoral approaches and demonstrate the advantages of this procedure. In addition we highlight the implementation of a navigation system which is routinely used in skull base surgery in our clinics.