Open-door maxillotomy approach for lesions of the clivus.

The transpalatal route to the clival region has been used to approach both extradural and intradural lesions. Classic transpalatal surgery, however, entails a partial splitting of the soft palate or some form of palatal retraction, which leaves behind a bony palate that hinders surgical exposure. When necessary, operative exposure can be enhanced by an open-door maxillotomy approach that uses a combination of a Le Fort I osteotomy of the maxilla and a paramedian sagittal split of the hard palate. The nasal septum is translocated to create a wide contiguous oronasal aperture through which the clival region can be reached unobstructed. This technique was used in three patients. No significant complications were observed in any patient. Features of this extended transpalatal approach, including indications and adjunctive measures to minimize potential complications, are discussed.