Le Fort I osteotomy and skull base tumors - A pediatric experience

Background: The le Fort I maxillary osteotomy approach for skull base tumor removal in the pediatric age group has nor been widely discussed in the literature except for sporadic case reports and limited case series. Objectives: To review our experience with the le Fort I osteotomy and to propose that it be used as an alternative approach because of its many advantages for the removal of tumors of the central skull base and paranasal sinuses. Design: Case series. Setting: Tertiary academic center. Patients and Methods: A 5-year retrospective charr review of cases involving children who had undergone skull base tumor resection via the Le Fort I osteotomy approach. Interventions: Skull base tumor removal via the Le Fort I osteotomy approach. Main Outcome Measures: Tumor type, location, and size; intraoperative and postoperative complications; and residual tumor and/or tumor recurrence associated with the surgical approach. Results: Eleven patients (9 boys and 2 girls; mean age, 14.3 years) were identified through the chart review. The tumor types included 8 angiofibromas, 1 malignant fibrous histiocytoma, 1 giant cell tumor, and 1 cavernous hemangioma. All these lesions had extensive tumor growth into at least 1 of the following sites: pterygomaxillary space, sphenoidal sinus, and areas adjacent to the optic nerve, cavernous sinus, clivus, and anterior cranial fossa. The mean follow-up for this cohort was 12.8 months. No intraoperative complications were noted. Postoperative complications were reviewed with respect to the approach. To date, there have been no cases of residual tumor or tumor recurrence that can be attributed to the procedure. Conclusions: Our experience suggests that the Le Fort I osteotomy approach is a useful technique for the removal of extensive central skull base tumors and paranasal sinuses in the pediatric age group. It has distinct advantages over traditional anterior or lateral approaches, including a more direct line of vision and improved exposure and cosmesis.