L-Shaped Zygotomy: A Safe and Versatile Modification of the Zygomatic Approach with Quantitative and Cosmetic Advantages in Skull Base Surgery.

Summary

In 35 patients, L-shaped zygotomy achieved 71% gross total resection with no new permanent facial palsy or wound complications and excellent long-term cosmetic scores. Cadaveric and 3D model analyses confirmed reduced flap retraction (−11 mm) and expanded anterior corridor (+3.9–4.2 mm) compared with conventional zygotomy.

Key Findings

• Retrospective series of 35 patients achieved 71% gross total resection with no new permanent facial palsy or wound complications.
• Mean follow-up 46 ± 14 months showed excellent cosmetic outcomes (surgeons 4.4/5, patients 4.7/5).
• Cadaveric and 3D model validation demonstrated 11 mm less skin flap retraction and 3.9–4.2 mm anterior corridor expansion versus conventional zygotomy.

Clinical Implications

Offers a reproducible approach for skull-base access that minimizes flap retraction and preserves facial contour, with validated long-term cosmetic outcomes and the option to escalate to OZ when needed.

Limitations

• Single-center retrospective design with no randomized comparison to conventional techniques.
• Limited sample size and potential selection bias; external validity requires multicenter validation.

Future Directions

Prospective multicenter comparisons with standardized cosmetic and functional endpoints; biomechanical studies optimizing osteotomy parameters and fixation for stability and cosmesis.