Topographic and anatomical comparison of the area of bone resection of petrosal squamosa and greater sphenoid wing down to the floor of middle cranial fossa in two-piece and three-piece orbitozygomatic approaches

Summary. Currently, many modifications of the orbitozygomatic approach (OZA) have been proposed, including the number of bone flaps. When performing a two-flap OZA, it is necessary to perform a resection of a part of the large wing of the sphenoid bone and squama of the temporal bone. Resection of these bones is associated with the risk of such a fairly frequent and underestimated cosmetic complication as temporal hollowing. In turn, when performing a three-flap OZA, proposed by A. Campero, conditions are created for reducing the area of bone resection at the base of the skull, which probably reduces the risk of developing a temporal hollowing. Objective. The objective was to compare a removal rate of the bones of of petrosal squamosa and greater sphenoid wing during two- and three-flap orbitozygomatic approaches. Materials and Methods. The study was conducted on 8 sides of the head-neck block preparations of cadaverous material of 6 deceased aged 45 to 86 years, whose death was not associated with a disease of the central nervous system. Results. The usage of three-flap orbitozygomatic approach allows reducing a removal rate of the bones of skull base by 274 mm2 . Discussion. When this bone fragment is preserved, the congruence of the skull is not disturbed, there is no need for resection of the bones of the skull base, there is no need to cut out the bone rim for the bone cuts connecting the superior and inferior orbital fissures, during the formation of the orbitozygomatic flap. Also, the risk of developing a cosmetic defect in the form of a temporal hollowing is probably to be reduced. However, the orbitozygomatic bone flap consists of two bone fragments, and therefore there is a need for additional bone fixation during its reconstruction. 

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