The Le Fort I-palatal split approach for skull base tumors: Efficacy, complications, and outcome

The Le Fort I, split-palate approach provides intraoral surgical access to a region of the midline skull base ranging from the upper clivus to the sec ond cervical vertebra. Although this approach provides perhaps the largest exposure of all the intraoral techniques, there is little concerning it in the literature. Furthermore, there are no detailed descriptions of case his tories, complications, and outcome. The purpose of this study was to evalua te this procedure's effectiveness and identify associated complications as well as outcome. Seven cases of patients who underwent eight skull base sur geries using the Le Fort I, split-palate approach were evaluated retrospect ively. Particular attention was paid to postoperative occlusion, speech, mo uth opening, infection, tumor recurrence, postoperative recovery period, an d viability of maxillary bone and teeth. Follow-up ranged from 4 months to 7 years with a mean of 3.9 pears. Pathologic diagnoses included three chord omas (two recurrent), one recurrent meningioma, one liposarcoma, one chondr osarcoma, and one inflammatory mass. One patient with chordoma underwent a second operation using the same approach. No deaths or major neurologic pro blems related to the procedure occurred. One patient who had known local me tastases at the time of operation died several months after surgery. All ot her patients are still Living. Duration of hospital stay ranged from 5 to 5 3 days with a mean of 25.4 days. Postoperative complications included one c ase of meningitis with an associated cerebrospinal fluid leak, three cases of malocclusion, one case of velopharyngeal insufficiency, and one extracra nial soft-tissue infection. The case of meningitis was successfully treated by antibiotics. The malocclusions were corrected by conservative treatment . No problems with mouth opening or bone or tooth viability occurred. Tumor recurred in both cases in which malignancy was involved, whereas only one recurrence was noted among the benign cases. It is concluded that the Le Fo rt I-palatal split technique is a relatively safe and effective means for a pproaching midline skull base tumors. Several modifications to the surgical protocol and surgical technique are detailed herein.