One-Piece Versus Two-Piece Orbitozygomatic Craniotomy:Quantitative And Qualitative Considerations

Abstract Objective: The orbitozygomatic (OZ) craniotomy minimizes brain retraction and improves cranial base exposure by providing a multidirectional view, increased operative angles and working space. The two main variations of the approach include the one-piece and the two-piece types. The microsurgical anatomy of the one- and two-piece OZ craniotomies are presented with the goal of comparing the extent of orbital roof removal between these two craniotomies and the effect of orbital roof removal on operative exposure. Methods: Ten two-piece and 11 one-piece OZ craniotomies were performed in a stepwise manner simulating the approaches on formalin fixed specimens. The orbital surface area removed above the frontozygomatic suture extending medially over the orbital roof was measured from each bone flap. The two-sided unpaired t test using STATA 7.0 software was used to compare the amount of orbital roof removed using the two approaches. Results: The two-piece OZ craniotomy allowed for the removal of a larger portion of the roof and lateral wall of the orbitthan the one-piece. The total orbitotomy, including the orbital roof plus the part of the lateral wall above the frontozygomatic suture, had an average surface area of 996 ± 229 mm2 for the two piece and 372 ± 103 mm2 for the one-piece. The orbital roof made up 27 ± 18% of the orbital osteotomy for the one-piece craniotomies and 67 ± 10% of the osteotomy for the two-piece craniotomies (P<0.001). Conclusion: The two-piece OZ craniotomy allows for more extensive orbital roof removal and better visualization of the basal frontal lobe. Therefore, the two-piece may result in a lower incidence of enophtalmus and poor cosmetic outcomes, particularly if the remaining orbital roof must be removed piecemeal during the one-piece OZ craniotomy in order to obtain satisfactory exposure.