A new direct approach to the area of the pterygomaxillary fossa and the parapharyngeal space is described. This procedure was developed because previously described methods either offered limited access to the area or resulted in significant functional defects. The approach described here results in a wide-field exposure of both the pterygomaxillary and parapharyngeal spaces with no sacrifice of either mandibular function or the sensory supply of the face or oral cavity. The parapharyngeal space is entered through a transcervical incision. This, combined with double osteotomies of the mandible, allows the ascending ramus with its intact neurovascular bundle to be reflected laterally and superiorly, along with the attached masseter muscle and the overlying skin. The result is an excellent exposure of the pterygomaxillary fossa and the base of skull. Following removal of the tumor, the ramus of the mandible is replaced and fixed with interosseous wiring and the application of arch bars, thus restoring normal dental occlusion. The technique described here was worked out on cadaveric dissection before being applied to a clinical case.

Rifampicin is effective in the treatment of patients with IGLM with complete clinical and ultrasonographic response after 6-9 months and could be used as a solo medical therapy alternative to both surgery and corticosteroids.

BackgroundTraditionally, conservative breast surgery was contraindicated in centrally located breast tumors, with total mastectomy as the treatment of choice. However, restorations of the central defects by the oncoplastic volume displacement or replacement techniques have been shown to be effective. The aim of the current study was to assess the surgical outcome of oncoplastic techniques after central breast tumors resection.MethodsThirty patients with central breast cancer, including two patients with Paget disease, treated at the Oncology Center of Mansoura University (Egypt) between June 2011 and December 2014 were included in this study. The oncoplastic techniques performed were Grisotti advancement rotational flap in eight (26.7 %) patients, classic skin-sparing mastectomy (SSM) with latissimus dorsi pedicled flap in 20 (66.7 %) patients, and skin-reducing mastectomy (SRM) with latissimus dorsi pedicled flap using wise pattern inverted T incision in two (6.7 %) patients. The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree.ResultsThe median age was 40.5 years (range; 23–55). There were no major complications that require repeating the oncoplastic techniques. Recorded complications included wound dehiscence (4/30, 13.3 %) donor site seroma (4/30, 13.3 %), and surgical site infection (1/30, 3.3 %). The 6-month subjective patient satisfaction was excellent in 21 (70 %) patients, good in 6 (20 %) patients, and fair in 3 (10 %) patients. There was no episode of local recurrence or systemic metastasis after an average follow-up duration of 24 months (range; 6–42).ConclusionsRestoring the central defect after resection of the central breast tumors can be safely achieved using oncoplastic procedures including the Grisotti technique or the design of SSM or SRM with immediate breast reconstruction. In our patients, these procedures yield a satisfactory esthetic outcome with lower morbidity.