ANALYTICAL EVALUATION OF COMPLEX ANTERIOR APPROACHES TO THE CRANIAL BASE - AN ANATOMIC STUDY

OBJECTIVE: The purpose of the present study was to evaluate the anatom ic areas of the cranial base exposed by different complex anterior app roaches. METHODS: Using 20 embalmed cadaveric heads, we executed five different anterior approaches, i.e., Le Fort 1 approach with splitting or down-fracturing of the hard palate, extended maxillectomy, median mandibulotomy with glossotomy, and mandibular swing transcervical appr oach. Each approach was performed a minimum of three times. The areas of the intra- and extracranial cranial base exposed by each approach w ere analytically examined by using a numerical grading system to asses s the exposure of major anatomic and neurovascular structures. RESULTS : Good exposure of the midline compartment of the cranial base was pro vided by the median mandibulotomy with glossotomy and by the Le Fort 1 approach with splitting of the hard palate, whereas the mandibular sw ing transcervical and extended maxillectomy approaches provided good e xposure of the lateral compartment of the cranial base. CONCLUSION: Us e of the numerical grading system allowed quantification of the exposu re afforded by each approach, with respect to the different compartmen ts (midline and lateral) of the intra- and extracranial cranial base, highlighting the differences among the approachers examined.