Three-Piece Orbitozygomatic Craniotomy: Anatomical and Clinical Findings

Objective: To describe the technical details of 3-piece orbitozygomatic (OZ) craniotomy using a diamond threadwire saw as an alternative to cutting the orbital rim and zygoma. Methods: The details of this procedure are presented by cadaver dissection and a surgical case. Results: Three-piece OZ craniotomy consists of 3 steps of bone flap elevation. First, the zygomatic arch is divided and reflected downward with the temporal muscle. This provides adequate exposure around the inferior orbital fissure with less skin flap retraction. In the second step, frontotemporal craniotomy is performed close to the skull base without the requirement for additional craniectomy. Finally, the superolateral wall of the orbital bone flap is elevated. Cutting the orbital rim and zygoma with a diamond threadwire saw allows reconstruction with a minimal bone gap. Conclusions: The herein-described 3-piece OZ craniotomy technique is simple and provides excellent brain exposure equivalent to that achieved by 1- and 2-piece OZ craniotomy while minimizing flap retraction and requiring less additional bone removal.