In this report, the technical details of a simple osteoplastic modified OZ craniotomy without removal of the zygoma to achieve adequate access are described. The osteoplastic component provides a subperiosteal tunnel beneath the temporalis muscle from the root of the zygoma to the anatomical keyhole while maintaining the attachment between the temporalis muscle belly and the temporal squama. This technique involves a one-piece osteoplastic bone flap that incorporates the frontal, temporal, and lateral portions of the orbital rim as a technically simpler alternative. The orbital rim component extends from just lateral to the supraorbital foramen/notch to the frontozygomatic suture. The osteoplastic bone flap minimally obstructs the surgical view and provides the advantages of the standard OZ exposure. Use of this technique avoids temporal hollowing from temporalis muscle atrophy or slumping while maintaining vascularization of the one-piece bone flap together with a decreased incidence of bone infection, and improves bone union with the calvaria.
The osteoplastic modified OZ craniotomy is easy to perform and offers extensive exposure of the skull base. Furthermore, the vascularized bone flap can be easily secured to the calvaria with anatomical reapproximation of the orbital rim and offers excellent long-term functional and cosmetic results.
We thank medical photographer Richard York for photographic assistance and Shirley McCartney, Ph.D., for assistance in figure preparation and editing.
Miyazawa T: Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures. Surg Neurol 50:347–3511998Miyazawa T: Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures. Surg Neurol 50: