The Le Fort I osteotomy approach for nasopharyngeal and nasal fossa tumors.

The nasopharynx, pterygopalatine fossa, and nasal fossa are difficult areas in which to gain wide surgical access. The transverse maxillary osteotomy with downfracturing of the entire palate and inferior maxilla has recently been adopted as a surgical option. Simultaneous bilateral wide surgical exposure is achieved in the maxillary, ethmoidal, and sphenoidal sinuses, nasal fossa, clivus, pterygopalatine fossa, and medial portion of the infratemporal fossa. Compared with other popular techniques, the transverse maxillary osteotomy provides excellent exposure for angiofibromas, clivus tumors, and other tumors of the central base of the skull and midface regions. The details of the procedure and relevant physiology of the osteotomized segment are presented. The safe attainment of wide surgical exposure will be demonstrated. This procedure has worldwide acceptance for orthognathic surgery and is easily adapted to head and neck oncologic surgery.