Three-Piece Orbitozygomatic Approach

OBJECTIVE: To describe the technical details of a 3-piece orbitozygomatic approach. INTRODUCTION: In a 3-piece orbitozygomatic approach, soft tissue exposure is mostly comparable to the classic frontopterional approach. Osseous resection is a 3-piece operation that consists of first performing anterior and posterior cuts along the zygomatic arch, reflecting it down, attached to the masseter. This is followed by a classic frontotemporosphenoidal craniotomy, and finally, an osteotomy of the orbital rim, roof, and lateral wall of the orbit. RESULTS: When compared with its 1- and 2-piece counterparts, 3-piece orbitozygomatic craniotomy, as described here, is a relatively simple operation and is thus advisable when considering an anterior or middle fossa approach. Brain exposure is wide, whereas cerebral retraction is minimal. We recommend avoiding orbit sectioning as deep as the superior orbital fissure. CONCLUSION: The modifications described herein show the technical features of the 3-piece orbitozygomatic approach, which provides excellent brain exposure with less retraction and a good cosmetic result.