Skull Base Tumors

the angle of the mandible to the lateral orbital rim. The internal jugular vein and internal carotid artery are isolated in the neck and controlled with vascular loops.

The temporalis muscle, with a cuff of pericranium, is elevated to the zygomatic arch. Having fashioned a fronto-temporal cran-iotomy, the lateral orbital rim and zygomatic arch are removed in a single piece and stored for later reconstruction. This allows access to the infratemporal fossa, and this access can be improved, if required, by removing the mandibular condyle.

Once the zygomatic arch is removed, the temporalis muscle can be dissected down to its insertion on the coronoid process. This allows an exposure of the undersurface of the sphenoid and temporal bones. A subperiosteal dissection of the subcranial part of the middle cranial fossa is performed from the glenoid fossa posteriorly, to the base of the pterygoid plates anteriorly and is carried medially to the foramen spin-osum and foramen ovale. These are the medial landmarks for the subsequent extension of the craniotomy.

The key to the exposure of the middle fossa and its immediate subcranial structures is an L-shaped craniotomy. This has a vertical component comprising the greater wing of the sphenoid and squamous part of the temporal bone, and a short horizontal component that ends at the foramen ovale and spinosum. The size of the craniotomy is determined by the extent of intracranial tumor. If exposure of the intra-petrous internal carotid is required, the cran-iotomy needs to be extended into the anterior part of the bony external auditory canal.

Extracranial and intracranial tumor can be removed simultaneously or in sequence. Closure of smaller resections may be achieved using the available temporalis muscle, but larger resections may once again require a microvas-cular free flap.

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Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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