A surgical modification for performing orbitozygomatic osteotomies: Technical note

James E. Conway, Shaan M. Raza, Khan Li, Michael W. McDermott, Alfredo Quiñones-Hinojosa

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


The addition of orbitozygomatic osteotomies to the fronto-temporo- sphenoidal craniotomy minimizes brain retraction required to reach deep seated pathology by allowing additional soft tissue dissection and strategic cranial bone removal. We report a modification of this technique in order to reduce soft tissue and cosmetic morbidity while increasing the efficiency with which this technique is performed. A two piece fronto-temporo-sphenoidal craniotomy combined with orbitozygomatic osteotomies was analyzed via cadaver dissection. The craniotomy and orbitozygomatic osteotomies were performed using the foot plate of the craniotome to facilitate the orbitozygomatic osteotomies. A similar technique was utilized in the operating room to safely create the two piece fronto-temporo-sphenoidal craniotomy and orbitozygomatic osteotomies in a series of patients. The illustrated technique was performed in cadavers and the results were analyzed in a series of 18 consecutive patients with minimum 3-month follow-up. Increased efficiency, good tissue preservation, and minimal soft tissue damage with no orbital injury were noted with a high rate of gross total lesional resection. With the added safety of a cutting instrument separated from the orbital soft tissues by a footplate, tissue trauma was minimized. Orbitozygomatic osteotomies are frequently added to the fronto-temporo-sphenoidal craniotomy in order to reach intracranial pathology that would previously have required excessive brain retraction to address. This manuscript details the use of a single drill system that can be used for both the craniotomy and the safe and efficient generation of orbitozygomatic osteotomies.

Original languageEnglish (US)
Pages (from-to)491-500
Number of pages10
JournalNeurosurgical Review
Issue number4
StatePublished - Oct 1 2010


  • Approach
  • Craniotomy
  • Orbitozygomatic
  • Skull base
  • Technique

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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