Maxillo-malar osteotomy as an approach to the clivus

Among various approaches to the clivus and upper cervical spine, transmaxillary access gives the neurosurgeon optimal visibility. Maxillo-malar osteotomy permitting the reflection of the osteotomized segment pedicled to the cheek after a Weber-Fergusson type cutaneous incision is the method that for the authors gives the best visibility. A wide operating field from upper clivus to C4 can be obtained by performing a maxillo-malar osteotomy associated with a midline splitting of hard and soft palate. The authors have performed this kind of access in five cases for neurosurgical purposes. Healing was always uneventful and no complications were observed. Occlusion was always restored without intermaxillary fixation, facial scars were of good quality and the only drawback was the section of infraorbital nerve.