Zygomatic-Transmandibular Approach for Giant Tumors of the Infratemporal Fossa and Parapharyngeal Space

Abstract

The zygomatic-transmandibular approach allows resection of giant lesions in the middle cranial base, when they are invading the infratemporal fossa and parapharyngeal space, with a low morbidity rate.

Craniofacial Resection for Cranial Base Malignancies Involving the Infratemporal Fossa

“…Many series in the literature have reported tumors of the infratemporal fossa that involve the lateral cranial base, posterior fossa, and clivus (8,9,15). The patients in our series with infratemporal fossa lesions were more anteriorly based with involvement of the maxillary sinus, anterior cranial base complex, and orbit.…”

“…It has been suggested that 2.5 cm is the smallest size at which a tumor may become symptomatic (16). Guinto et al (9) reported a series in which the median tumoral diameter was 8 cm at presentation. Some of most common tumors operated in the infratemporal fossa are benign angiofibromas, sphenoid-wing meningiomas, and trigeminal schwannomas, all of which may be cured with gross total resection (8,9,12).…”

“…The exposure includes an epidural dissection of the greater wing of the sphenoid, the medial extent of which extends from foramen rotundum to foramen ovale. Type 1 dissection is performed through a frontotemporal flap without zygomatic osteotomy (8,9,12,15) or resection of the external ear canal (8), as described by others. Mandibulectomy was only required in selected cases for tumor resection but was not necessary for exposure.…”

“…Tumor resection was avoided in this region because of the perceived biological aggressiveness of these tumors, difficulty in achieving negative histological margins, and the associated surgical morbidity and mortality. Although several articles have provided outcome data for resection of anterior cranial base tumors (1)(2)(3)(4)(5)(6)(7)10,13,14), very few authors have addressed cranial base malignancies specifically involving the infratemporal fossa (2,9).…”

Pleomorphic Adenoma in the Infra-temporal Space: The First Case Report

“…There are numerous surgical approaches, indicating the difficulty of access, accentuated by the communications with the neighboring regions. The main obstacles approaching the infratemporal fossa are the zygomatic arch, the parotid gland, the facial nerve and the ascending ramus of the mandible [11]. Thus for our case, a modified surgical approach was performed with a zygomatic arch access osteotomy and coronoidotomy to excise the tumor mass from the infratemporal fossa.…”