Maxillary-fronto-temporal approach for removal of recurrent malignant infratemporal fossa tumors: Anatomical and clinical study

Purpose: For recurrent malignant tumors occurring in the infratemporal fossa, it is difficult to select a proper surgical approach. We explore the efficiency of a new approach for removal of recurrent malignant tumors involving the infratemporal fossa based on the measurement on three-dimension CT, observation of six cadaveric specimens, and our surgical experience. Materials and methods: The distances between the surgical landmarks in the infratemporal fossa were measured using CT data to determine the safe distance. And anatomy observation was examined on 6 formalin-fixed cadaveric specimens. Data from seven patients with recurrent malignant infratemporal fossa tumors were retrospectively analyzed. Results: The mean distance of the medial pterygoid plate from the zygoma was 52.12 mm. The maxillary artery can be found between the deep surface of the condyle and the sphenomandibular ligament, with mean distance of 8.25 +/- 3.22 mm to the inferior border of the capsule of the temporomandibular joint. All tumors got gross resection using the maxillary-fronto-temporal approach with minor complication. Conclusions: The advantages of the new approach include adequate protection of facial nerve with extended operation field; the exposed temporal muscle could be used to fill the dead space. This technique is especially useful to remove recurrent malignant infratemporal tumors safely. (C) 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.