Commentary [Frontozygomatic Approach to Intraorbital Tumors]

Yoshihiro Numa described his experience using the frontozygomatic approach to treat orbital tumors. He obtained excellent results. As the author notes, this approach provides excellent exposure of intraorbital tumors affecting the medial or posterior half of the orbit and for those that extend intracranially. The frontozygomatic approach minimizes mobilization of the temporalis muscle and improves cosmetic outcomes. When the tumor extends into the middle fossa, the approach needs to be converted to a full orbitozygomatic approach[1] or combined with division of the zygomatic arch and greater mobilization of the temporalis muscle.[2] Atrophy of the temporalis muscle can be minimized by avoiding use of unipolar cauterization for dissection and by leaving the muscle attached to the zygomatic arch.

At my institution these tumors are managed using a team approach with an experienced ophthalmologic surgeon and neurological surgeon. A team approach ensures the best opportunity to obtain complete resection of the tumor while preserving or restoring visual function.

REFERENCES

• 1 Zabramski J M, Kiris T, Sankhla S K, Cabiol J, Spetzler R F. Orbitozygomatic craniotomy. Technical note.  J Neurosurg. 1998;  89 336-341
• 2 Lemole Jr G M, Henn J S, Zabramski J M, Spetzler R F. Modifications to the orbitozygomatic approach. Technical note.  J Neurosurg. 2003;  99 924-930