Abstract
Background Zygomatic osteotomy, an adjunct to middle cranial fossa (MCF) surgical approaches,
improves the superior-inferior angle of approach and minimizes temporal lobe retraction.
However, a decision-making algorithm for selective use of the zygomatic osteotomy
and the impact of the zygomatic osteotomy on surgical complications have not been
well documented.
Objective We described an algorithm for deciding whether to use a zygomatic osteotomy in MCF
surgery and evaluated complications associated with a zygomatic osteotomy.
Methods A retrospective review of MCF cases over 11 years at our academic tertiary referral
center was conducted. Demographic variables, tumor characteristics, surgical details,
and postoperative complications were extracted.
Results Of the 87 patients included, 15 (17%) received a zygomatic osteotomy. Surgical trajectory
oriented from anterior to posterior (A-P) was significantly correlated with the use
of the zygomatic osteotomy. Among the cases approached from A-P, we found (receiver-operating
characteristic curve) that the cut-off tumor size that predicted a zygomatic osteotomy
was 30 mm. Of the 87 cases included, 15 patients had a complication. The multivariate
logistic regression model failed to reveal any significant correlation between complications
and zygomatic osteotomies.
Conclusions We found that the most important factor determining the use of a zygomatic osteotomy
was anticipated trajectory. A-P approaches were most highly correlated with zygomatic
osteotomy. Within those cases, a lesion size cut-off of 30 mm was the secondary predicting
factor of zygomatic osteotomy use. The odds of suffering a surgical complication were
not significantly increased by use of zygomatic osteotomy.
Keywords
zygomatic osteotomy - middle cranial fossa - skull base - surgical approaches - surgical
adjuncts