The Transoral-Transmaxillary Access Route to the Anterior Vertebral Column and Skull Base

Purpose: The indications, technique, and results of the above-mentioned approach to the skull base are described.

Method: The median approach via the palate, velum, or following the Le Fort I osteotomy allows the treatment of fractures, tumors, infections, or malformations. In addition the upper anterior vertebral column, the clivus, sphenoidal sinus, and the orbit's apex can be accessed via this route.

Result: In comparison with the approaches described by Raveh, a vast area of the cranial base can be explored and the manual manipulation, bone transplantation, and the osteosynthesis at the craniocervical border using the transoral-transpalatine approach proves easier, more direct, and enables greater visual control of the operating field. Furthermore, this 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 becomes necessary, the buccal-transpalatine approach can be implemented, facilitating access to vast regions of the visceral cranium. With the advent of technical innovations like navigation systems in combination with intraoperative x-ray systems, improved surgical orientation as well as accuracy can be achieved, proving beneficial to the surgeon and patient alike.

Conclusion: In this presentation the transoral-transmaxillary approaches are featured by themselves and in conjunction with extraoral approaches to demonstrate the advantages of these procedures. Additionally the implementation of an intraoperative navigation system with intraoperative back-up via a three-dimensional C-arm based on the cone beam computer tomography, and the derived advantages of this combination, are demonstrated.