[Surgery of the infratemporal fossa. An improved cutaneous access technic].
Surgery in the infra-temporal area, formerly known as the pterygo-maxillary area, is not often performed and raises several problems including the route of access and indications and contraindications. Many procedures have been proposed by ENT or maxillo-facial surgeons dealing with cancer.


METHODS
The infratemporal area is a basically pyramidal shaped, very deep region of the face. The base of the pyramid formed by the medial aspect of the ramus is triangular and the upper surface of the pyramid is the floor of the skull. The anteromedial aspect corresponds to the posterior aspect of the maxillary bone and the posteroinferior aspect to the pterygomaxillary fascia.


METHODS
This type of surgery is generally indicated for locoregional cancers and exceptionally for benign tumors originating in this area, e.g. angiomas, neurinomas of the dental or lingual nerve, either as single tumours or as part of a Recklinhausen disease. Most often, the surgeon is faced with the problem of infra-temporal invasion of a tumour originating outside the area: malignant tumour of the sinus (epidermoid epithelioma), salivary glands, bone tumours, etc. The main problem is naturally to determine the route of access, via the ramus, the parotid, the maxillary sinus or the submandibular region. In the author's opinion, the upper route via a coronal incision combined with a lifting incision on the same side is a particularly interesting approach. Different situations may arise: parotidectomy is required with preservation of the VIIth nerve, resection of the ramus or anterior section, making it possible to fold back the lateral part involved and thus provide sufficient access.
Institut de Stomatologie, Chirurgie Plastique et Chirurgie Maxillo-faciale, CHU Pitié-Salptrière, Paris.
J M
JM
Vaillant
D000564:Ameloblastoma / Q000601:surgery; D004954:Esthetics; D005153:Facial Neoplasms / Q000601:surgery; D005205:Fascia / Q000033:anatomy & histology; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008334:Mandible / Q000033:anatomy & histology / Q000601:surgery; D008437:Maxilla / Q000033:anatomy & histology / Q000601:surgery*; D008443:Maxillary Sinus / Q000033:anatomy & histology; D009220:Myositis / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010306:Parotid Gland / Q000601:surgery; D011626:Pterygoid Muscles / Q000033:anatomy & histology; D013100:Sphenoid Bone / Q000033:anatomy & histology / Q000601:surgery*; D013701:Temporal Bone / Q000033:anatomy & histology / Q000601:surgery*; D015050:Zygoma / Q000601:surgery
Chirurgie de la fosse infra-temporale. Une voie d'abord cutanée améliorée.