Journal of Current Surgery, ISSN 1927-1298 print, 1927-1301 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Curr Surg and Elmer Press Inc
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Case Report

Volume 6, Number 2, June 2016, pages 60-64

Fronto-Temporo-Zygomatic Approach for Orbital Apex and Infratemporal Fossa

Figures

Figure 1.
Figure 1. Proptosis of right eye and fixed eyeball seen when the patient came to OPD, with dilated pupil. This finding was correlating with poor vision of the patient from the same eye.
Figure 2.
Figure 2. Plain coronal view computed tomography of orbit and paranasal sinuses showing infratemporal fossa infiltration and widening of the space.
Figure 3.
Figure 3. Magnetic resonance imaging plain axial view showing orbital apex edema infiltration of right eye, edematous lateral rectus muscle.
Figure 4.
Figure 4. Hairline coronal incision. The advantage of this incision is that it hides in the hairs and so is cosmetically appealing.
Figure 5.
Figure 5. Skin flap elevated over the superficial temporalis fascia.
Figure 6.
Figure 6. Subgaleal pad of fat with superficial temporalis fascia layer elevated.
Figure 7.
Figure 7. Musculoperiosteal flap elevated to expose the bony frame work. Muscle is inferiorly displaced.
Figure 8.
Figure 8. En bloc craniotomy done with inferiorly based single muscle flap.
Figure 9.
Figure 9. Orbital apex lesion.
Figure 10.
Figure 10. Post-surgery, repositing back the en bloc craniotomy and fastening the assembly with titanium screws and plates. Titanium has a property of osseo-integration.
Figure 11.
Figure 11. Pre- and postoperative optic disc pictures. Preoperatively optic disc was edematous dull. Six days postoperatively, the edema subsided and disc appeared normal.
Figure 12.
Figure 12. Histopathology slide reported as chronic non-specific inflammatory infiltrate/pseudotumor.

Table

Table 1. Various Modified Trans-Facial Pre-Auricular Approaches to Orbital Apex and Infratemporal Fossa
 
NameApproachLesions
Pellerin et alOrbito-fronto-mallar approachOrbital meningioma
Hakuba et alOrbito-zygomatic ITF approach
Fronto-orbito-temporal craniotomy. Three separate bone flaps		Cavernous sinus lesions
FrazierConcept of removing orbital rimsImproved exposure of skull base
Delashaw et alFronto-temporal flap + superior and lateral orbital rim + frontal sinus. Zygomatic arch removed separatelyAnterior fossa, middle fossa, orbit, cavernous sinus
McDermottRemoval of fronto-temporal and orbito-zygomatic bone flaps separately
Al MeftyIncorporated superior orbital ridges with pterional craniotomy
Morwani et alModified fronto-temporo-zygomatic approachLimited disease in ITF, lateral orbit and orbital apex