Approach to en bloc resection and reconstruction of primary masticator space malignancies

Castro, Jerry R.; Likhterov, Ilya; Mehra, Saral; Bassiri-Tehrani, Michael; Scherl, Sophie; Clain, Jason B.; Buchbinder, Daniel; Urken, Mark L.

doi:10.1002/lary.25500

Cited by 6 publications

(9 citation statements)

References 18 publications

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“…However, new surgical techniques, such as endoscopicassisted access to the masticator space, and improved reconstruction techniques have allowed for growing evidence that some of these lesions may in fact be amenable to surgical extirpation, with a reasonable possibility of achieving negative margins and improved functional outcomes. [3][4][5][6][7]10,14 In this study, we examined all cases of T4b OCSCC in the NCDB and investigated the outcome of different treatment approaches. We found that patients who were treated with primary surgery 1 CRT experienced longer survival as compared with those treated with CRT alone on multivariable and propensity score-matched analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Up‐front surgery might not be considered for T4b tumors of the oral cavity due to the difficulty in obtaining adequate margins. However, new surgical techniques, such as endoscopic‐assisted access to the masticator space, and improved reconstruction techniques have allowed for growing evidence that some of these lesions may in fact be amenable to surgical extirpation, with a reasonable possibility of achieving negative margins and improved functional outcomes 3–7,10,14 . In this study, we examined all cases of T4b OCSCC in the NCDB and investigated the outcome of different treatment approaches.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 A single-institution study of 25 patients recently suggested a benefit of adjuvant chemoradiotherapy (CRT) to primary surgery and a disease-specific survival of 63.2% at 2 years. 9 With more advanced techniques being developed for surgical access to the masticator space, 10,11 it seems justified to reassess the very locally advanced classification of these lesions (unresectable in the prior editions). We utilized the National Cancer Database (NCDB), the largest cancer database in the United States, to analyze the patterns of treatment of patients with T4b OCSCC and associated outcomes.…”

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confidence: 99%

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Primary Surgical Treatment in Very Advanced (T4b) Oral Cavity Squamous Cell Carcinomas

Patel¹,

Oliver²,

Vaezi³

et al. 2021

Otolaryngol.--head neck surg.

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Objectives To describe patterns of primary surgical treatments in patients with T4b oral cavity squamous cell carcinoma (OCSCC). Study Design Historical cohort study. Setting National Cancer Database. Methods Review of the National Cancer Database between 2004 and 2017 for all T4b OCSCCs. Only patients with curative treatment methods were included in the survival analysis. Surgical and nonsurgical outcomes were compared by multivariable and propensity score matching analysis. Results A total of 1515 cases of T4b OCSCC were identified. A minority of patients (n = 363, 24.0%) underwent curative treatment; among these, 206 (56.7%) underwent primary surgery. Median length of follow-up was 24 months. The 90-day mortality of patients who underwent surgical treatment was 1.0%. The 2-year survival was higher for patients who underwent surgery + chemoradiotherapy (CRT) as compared with CRT (64.6% vs 45.2%, P < .001). On multivariable analysis, surgery + CRT was associated with longer survival. In a propensity score–matched cohort of 312 patients, 2-year survival remained higher in the surgical group versus the nonsurgical group (59.4% vs 45.5%, P = .02). Among patients who underwent surgery + CRT, there was no difference in 2-year survival between clinical T4a and T4b (59% vs 64.6%, P = .20). Conclusions A minority of patients with T4b OCSCC undergo treatments with curative intent. A subset of patients underwent primary surgical treatment, which was associated with longer survival. The T4b classification might entail a heterogenous group, and further studies in revision of this classification might be justified.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Primary Surgical Treatment in Very Advanced (T4b) Oral Cavity Squamous Cell Carcinomas

Patel¹,

Oliver²,

Vaezi³

et al. 2021

Otolaryngol.--head neck surg.

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“…The third division of the trigeminal nerve and its branches passes through this space, and the internal maxillary artery with its branches runs through this space and enters the pterygopalatine fossa13. Several spaces are in contact with the masticator space, such as the buccal and retroantral spaces anteriorly, parapharyngeal space medially, and parotid space laterally.…”

Section: Discussionmentioning

confidence: 99%

“…The Conley's lateral approach of extending the preauricular incision to the neck with a second submandibular incision has been proposed but has the disadvantages of facial incision and bony defect along with the sacrifice of inner deep structures14. Later, Castro et al13 revised this method and published an approach to malignant tumors of the masticator space through a preauricular incision and transcervical incision; however, this method also has the burden of bypassing facial nerve trunks to access inner neoplasms. Dingman and Conley15 introduced an inferior approach through the submandibular incision that included midline lip splitting and posterior extension to the mastoid process.…”

Section: Discussionmentioning

confidence: 99%

Squamous cell carcinoma of the buccal mucosa involving the masticator space: a case report

Kim

Myoung

2017

J Korean Assoc Oral Maxillofac Surg

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Squamous cell carcinoma of the buccal mucosa has an aggressive nature, as it grows rapidly and penetrates well with a high recurrence rate. If cancers originating from the buccal mucosa invade adjacent anatomical structures, surgical tumor resection becomes more challenging, thus raising specific considerations for reconstruction relative to the extent of resection. The present case describes the surgical management of a 58-year-old man who presented with persistent ulceration of the mucosal membrane and a mouth-opening limitation of 11 mm. Diagnostic imaging revealed a buccal mucosa tumor that had invaded the retroantral space upward with involvement of the anterior border of the masseter muscle by the lateral part of the tumor. In this report, we present the surgical approach we used to access the masticator space behind the maxillary sinus and discuss how to manage possible damage to Stensen's duct during resection of buccal mucosa tumors.

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Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

Patel,

Haleem,

Choudhry

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo compare surgical and nonsurgical definitive treatment in cT4b major salivary gland cancer (MSGC).Study DesignRetrospective cohort study.SettingThe 2004 to 2019 National Cancer Database.MethodsThe NCDB was queried for patients with cT4b MSGC (N = 976). Patients undergoing definitive treatment with (1) surgical resection + adjuvant therapy, (2) radiotherapy (RT) alone, or (3) chemoradiotherapy (CRT) were included in Kaplan‐Meier and Cox survival analyses.ResultsOf 219 patients undergoing definitive treatment, 148 (67.6%) underwent surgical resection + adjuvant therapy and 71 (32.4%) underwent RT or CRT. There were no documented mortalities within 90 days of surgical resection. Tumor diameter and nodal metastasis were associated with decreased odds of undergoing definitive treatment (P < 0.025). Patients with positive surgical margins (PSM) had higher 5‐year overall survival (OS) than those undergoing definitive RT or CRT (48.5% vs 30.1%, P = 0.018) and similar 5‐year OS as those with negative margins (48.5% vs 54.0%, P = 0.205). Surgical resection + adjuvant therapy (adjusted hazard ratio: 0.55, 95% confidence interval [CI]: 0.37‐0.84) was associated with higher OS than definitive RT or CRT (P < 0.025). A separate cohort of 961 patients with cT4a tumors undergoing surgical resection + adjuvant therapy was created; cT4a and cT4b (hazard ratio: 1.02, 95% CI: 0.80‐1.29, P = 0.896) tumors had similar OS.ConclusionA minority of patients with cT4b MSGC undergo definitive treatment. Surgical resection + adjuvant therapy was safe and associated with higher OS than definitive RT or CRT, despite high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b MSGC may benefit from surgical resection.

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Approach to en bloc resection and reconstruction of primary masticator space malignancies

Abstract: 4.

Cited by 6 publications

References 18 publications

Primary Surgical Treatment in Very Advanced (T4b) Oral Cavity Squamous Cell Carcinomas

Primary Surgical Treatment in Very Advanced (T4b) Oral Cavity Squamous Cell Carcinomas

Squamous cell carcinoma of the buccal mucosa involving the masticator space: a case report

Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

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