Total Maxillary Swing Approach to the Skull Base for Advanced Intracranial and Extracranial Nasopharyngeal Angiofibroma

Abstract

The main objective of surgical approaches to the anterior and anterolateral skull base is to have maximum exposure so injury to important structures is avoided, and surgical complications are reduced. At our institution, we used total maxillary swing (TMS) to approach the anterior and anterolateral skull base for resection of both malignant and benign tumors. We modified some of the techniques described in TMS to avoid complications encountered previously. The purpose of this article was to present the usefulness of TMS for maximum exposure of the anterior and anterolateral skull base using advanced nasopharyngeal angiofibroma (NPA) as the reference disease.We retrospectively reviewed 16 patients who underwent excision of NPA by TMS from 2005 to May 2011. The operative techniques, operative findings, postoperative complications, and follow-up records were reviewed and analyzed.Of the 16 cases of NPA, 5 had intracranial extensions. All had lateral extensions to the pterygopalatine fossa. The pterygoid base was explored in all cases. In 10 cases, the tumors were present in the spongy bone of the pterygoid bases, whereas in 6 cases, the base of the pterygoids was eroded and floating. In all cases, the tumor was completely removed. Complications encountered previously were avoided by the modifications to TMS. Complications encountered because of extensiveness of the tumor were easily managed. No patients had any recurrence until now.Total maxillary swing provides maximum exposure to the anterior and anterolateral skull base for complete removal of the tumors in those areas with minimal complications.