Maxillary Removal and Reinsertion for Anterior Cranial Base Tumors

Sharma, Pramod Kumar; Schuller, David E.; Goodman, Joseph H.; Smith, Stephen P.; Goldman, Fedrico P.; Raj, Sonia; Nicholson, Roy E.; Young, Donn C.

doi:10.1001/archotol.124.2.149

Cited by 6 publications

(2 citation statements)

References 8 publications

(9 reference statements)

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“…1, demonstrated at right side of nasopharynx); the lateral border was via the posterior wall of the maxillary sinus, including medial or lateral pterygoid plates, and extending posteriorly to meet the posterior margin of resection. In patient 17 with T2b tumor, and for the second surgery of patient 27 with T3 tumor, the nasopharynx was approached through facial translocation modified by maxillary reinsertion, 19 and the internal carotid artery was dissected out and covered with temporalis muscle after tumor removal (patient 27) or ligated and resected with the tumor (patient 17;Fig. 1, left side of nasopharynx).…”

Section: Methodsmentioning

confidence: 99%

Salvage Surgery for Recurrent Nasopharyngeal Carcinoma

et al. 2000

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Objective: To evaluate the efficacy of salvage surgery in the treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site. Study Design: A retrospective investigation of the outcome of salvage surgery for 28 patients with recurrent NPC after definite radiation therapy. Methods: The nasopharynx was approached anteroposteriorly by the transmaxillary approach (maxillary swing, maxillectomy) or inferior approach (midline mandibulotomy or median labiomandibular glossotomy), or laterally by modified facial translocation or transpterygoid approach; intentional ligation of the internal carotid artery was performed after establishment of extracranialintracranial (EC-IC) bypass in one patient; postoperative irradiation was given to the patients with positive pathological margins. Results: Nine patients lived without disease for 20 to 93 months (mean interval, 52 mo) after surgery; among them, eight patients had T1 tumors that were resected totally by surgery via anteroposterior approaches and the other patient had postoperative irradiation to control the disease. Seven patients had local recurrence 8 to 21 months after treatment. Four patients developed distant metastases, including one patient with a T2b tumor that was totally resected through modified facial translocation approach with ligation of internal carotid artery. Eight patients died of other causes; internal carotid artery blowout was the cause of death in four of these eight patients. Conclusions: In most cases of recurrence, T1 nasopharyngeal tumors can be resected totally by anteroposterior approaches; for T2 or larger tumors, postoperative irradiation is usually necessary. Otherwise, facial translocation offers a better chance to completely resect the tumors. Internal carotid artery is better ligated if patients have received greater than 70 Gy irradiation or if the artery must be exposed during the surgery. We suggest that EC-IC bypass be used to avoid the possible complications (or cerebral ischemic stroke) caused by ligation of internal carotid artery. The transmaxillary approach is favored in the management of nasopharyngeal tumor recurrence with nasal cavity extension, and midline mandibulotomy is more suitable for resection of posterior margin of nasopharyngeal tumor recurrence. Facial translocation offers the widest operative field and is the most versatile approach for radical resection of nasopharyngeal tumor recurrence, but the surgeon should be skilled in the management of the facial nerves to reduce morbidity.

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Section: Methodsmentioning

confidence: 99%

Salvage Surgery for Recurrent Nasopharyngeal Carcinoma

et al. 2000

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“…This surgical approach has been used successfully in the past 18 years. Its feasibility 5 and safety in a pediatric patient population have also been studied 6 . The goal of this study is to assess long‐term results of an expanded series of MRRI with 18‐year surgical experience and to discuss the feasibility of this technique in extensive ACB lesions, especially extending laterally toward the pterygopalatine and infratemporal fossae.…”

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confidence: 99%

Maxillary removal and reinsertion: A favorable approach for extensive anterior cranial base tumors

Özer

Bapna

Agrawal

et al. 2010

Otolaryngol.--head neck surg.

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Maxillary Removal and Reinsertion in Pediatric Patients

Powell

Shah²,

Carr

et al. 2002

Arch Otolaryngol Head Neck Surg

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No major long-term complications were identified in the patients after MRR. Cephalometric analysis revealed minor abnormalities in 2 children, but no plate migration or bony resorption was identified in the removed and reinserted maxillae. No abnormal development patterns were detected on physical examination or when cephalometric measurements were compared with age- and race-matched normative data. Although further study is warranted, MRR seems safe and effective for treatment of pediatric patients with anterior cranial base tumors.

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Maxillary Removal and Reinsertion for Anterior Cranial Base Tumors

Abstract: Maxillary removal allows improved visualization and access to anterior skull base lesions, while reinsertion of the maxillary fragment provides functional preservation and excellent cosmesis with few short- or long-term complications, even when adjuvant radiotherapy is used.

Cited by 6 publications

References 8 publications

Salvage Surgery for Recurrent Nasopharyngeal Carcinoma

Salvage Surgery for Recurrent Nasopharyngeal Carcinoma

Maxillary removal and reinsertion: A favorable approach for extensive anterior cranial base tumors

Maxillary Removal and Reinsertion in Pediatric Patients

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