[Anterior bulbar compresion with basilar impresion. Surgical management by 2-Piece Le Fort I Transmaxilar Osteotomy]

The expansive lesions, whether tumoral or not, originated at the level of the anatomical region of the skull base (SB), show a great histologic variety and clinicaly they cause a variable chronic neurological disfunction. Surgical treatment appears to be the best therapeutic option. An exhaustive knowledge of the topographic anatomy of this area is the mandatory in order to design an appropriate surgical strategy. In many cases, a narrow cooperation with specialists is necesary. As in any other surgical activity, a complete excision of the lesion and an optimal functional and aesthetic rehabilitation, without complications, is the challenge of the surgical team. The approach to the anatomical area of the SB is not single, but is based on a number of procedures, although none of them could be considered the best, or without technical difficulty or any complications. Within the group of transoral approaches, the Le Fort I-Palatal split (LFPS) technique has been considered by different authors an excellent way to approach the clivus and the occipito-vertebral joint. We report the case of a patient, treated in cooperation with the Department of Neurosurgery of our hospital. He was clinical and radiologically diagnosed of basilar impresion with bulbar compression, and the MRI revealed the presence of a located extradural fibrous injury above the odontoid apophysis. Therefore we chose the use of a LFPS to approach this lesion. With an optimal surgical field, a complete excision of the lesion was obtained. The postoperatory result in the subsequent follow-up was highly satisfactory.