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Lower Maxillotomy Route to the Clivus and Foramen Magnum

Surgical Correlation

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A, The approach can be made through a degloving incision inside the mouth; however, in this case, to more fully show the anatomy, a Weber-Fergusson paranasal incision with an infraorbital extension is used to expose the anterior face of the maxilla. The infraorbital nerve has been divided, although it can usually be preserved with the degloving incision. The masseter is attached along the lower margin of the zygoma. B, The mucosal lining the maxillary sinus is exposed below the zygomatic arch. The coronoid process of the mandible is removed or reflected with the temporalis muscle to expose the medial and lateral pterygoid muscles and the maxillary artery in the infratemporal fossa. C, The lateral pterygoid muscles and a segment of the maxillary artery have been removed. Removal of the lateral pterygoid exposes the mandibular nerve and its branches in the medial part of the infratemporal fossa. D, A lower maxillectomy has been completed. In this approach, the maxilla can be folded on a vascularized pedicle of soft palate into the floor of the mouth. The pterygoid process, which forms the posterior wall of the pterygopalatine fossa, has been preserved. The nasal mucosa remains intact. The maxillary artery exits the infratemporal fossa to enter the pterygopalatine fossa. (Images courtesy of AL Rhoton, Jr.)

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