Abstract
The transpalatal route to the clival region has been used to approach both extradural
and intradural lesions. Classic transpalatal surgery, however, entails a partial splitting
of the soft palate or some form of palatal retraction, which leaves behind a bony
palate that hinders surgical exposure. When necessary, operative exposure can be enhanced
by an open-door maxillotomy approach that uses a combination of a Le Fort I osteotomy
of the maxilla and a paramedian sagittal split of the hard palate. The nasal septum
is translocated to create a wide contiguous oronasal aperture through which the clival
region can be reached unobstructed. This technique was used in three patients. No
significant complications were observed in any patient. Features of this extended
transpalatal approach, including indications and adjunctive measures to minimize potential
complications, are discussed.
