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Lower Maxillotomy Route to the Clivus and Foramen Magnum

Surgical Correlation

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E, The nasal mucosa has been opened and the posterior pharyngeal wall reflected to the opposite side. The longus capitis attachments have been separated from the clivus. F, The longus capitis and longus coli have been reflected laterally to expose the anterior arch of the atlas and the dens and body of the axis. G, The clivus and the dura have been opened to expose the medulla and vertebral arteries. H, The exposure has been extended upward by removing the anterior wall of the sphenoid sinus and sella. The terminal part of the petrous carotids limits the lateral exposure at the level of the clivus, and the cavernous carotids limit the lateral exposure at the level of the sphenoid sinus. The intercavernous sinuses interconnect the paired cavernous sinuses. (Images courtesy of AL Rhoton, Jr.)

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