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The frontotemporal-orbitozygomatic approach: reconstructive technique and outcome

  • Clinical Article
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Abstract

Background

The frontotemporal-orbitozygomatic (FTOZ) approach, also known as “the workhorse of skull base surgery,” has captured the interest of many researchers throughout the years. Most of the studies published have focused on the surgical technique and the gained exposure. However, few studies have described reconstructive techniques or functional and cosmetic outcomes. The goal of this study was to describe the surgical reconstruction after the FTOZ approach and analyze the functional and cosmetic outcomes.

Methods

Seventy-five consecutive patients who had undergone FTOZ craniotomy for different reasons were selected. The same surgical (one-piece FTOZ) and reconstructive techniques were applied in all patients. The functional outcome was measured by complications related to the surgical approach: retro-orbital pain, exophthalmos, enophthalmos, ocular movement restriction, cranial nerve injuries, pseudomeningocele (PMC) and secondary surgeries required to attain a reconstructive closure. The cosmetic outcome was evaluated by analyzing the satisfaction of the patients and their families. Questionnaires were conducted later in the postoperative period. A statistical analysis of the data obtained from the charts and questions was performed.

Results

Of the 75 patients studied, 59 had no complications whatsoever. Ocular movement restriction was found in two patients (2.4 %). Cranial nerve injury was documented in seven patients (8.5 %). One patient (1.2 %) underwent surgical repair of a cerebrospinal fluid (CSF) leak from the initial surgery. Two patients (2.4 %) developed delayed postoperative pseudomenigocele. One patient (1.2 %) developed intraparenchymal hemorrhage (IPH). Full responses to the questionnaires were collected from 28 patients giving an overall response rate of 34 %. Overall, 22 patients (78.5 %) were satisfied with the cosmetic outcome of surgery.

Conclusion

The reconstruction after FTOZ approach is as important as the performance of the surgical technique. Attention to anatomical details and the stepwise reconstruction are a prerequisite to the successful preservation of function and cosmesis. In our series, the orbitozygomatic osteotomy did not increase surgical complications or alter cosmetic outcomes.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, University of South Florida, Tampa, FL, USA

    A. Samy Youssef, Angela Downes, Raul Olivera, Siviero Agazzi & Harry van Loveren

  2. Tampa General Hospital, Tampa, FL, USA

    Laura Willard

  3. Department of Otolaryngology, University of South Florida, Tampa, FL, USA

    Kathryn Hall

  4. 2 Tampa General Circle, USF Health Science Center, Tampa, FL, 33606, USA

    A. Samy Youssef

Authors
  1. A. Samy Youssef
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  2. Laura Willard
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  3. Angela Downes
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  4. Raul Olivera
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  6. Siviero Agazzi
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  7. Harry van Loveren
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Correspondence to A. Samy Youssef.

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Comment

This article describes an experienced group of skull base surgeons honestly presenting their complications related to the variants of the orbitozygomatic approach. With respect to the nomenclature used, the only true FTOZ is the fourth variant in the figures, as the other three variants do not take down the zygoma. When the data were stratified by FTOZ variant, the authors found the full FTOZ variant and frontal variant were associated with higher complication rates (36.4 and 42.9 %, repsectively) compared to the orbitopterional variant, which was associated with a mcuh lower rate (13 %) of complications. While there was no statistical significance, the variation in rates are wide, and one might suspect these would become significant with greater "n" in each category. This study did not evaluate frontalis weakness, which in our own experience is much higher in cases with orbital bar removal. Overall, the authors should be commended for this study, which adds valuable information to the literature regarding the outcome of these variants of a commonly performed skull base approach.

WT Couldwell

Utah, USA

Poster presentation

The Frontotemporal-Orbitozygomatic Approach: Reconstructive technique and Outcome: Congress of Neurological Surgeons Annual Meeting, San Francisco, CA, October 2010

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Youssef, A.S., Willard, L., Downes, A. et al. The frontotemporal-orbitozygomatic approach: reconstructive technique and outcome. Acta Neurochir 154, 1275–1283 (2012). https://doi.org/10.1007/s00701-012-1370-9

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  • DOI: https://doi.org/10.1007/s00701-012-1370-9

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