Combined intraoral and lateral temporal approach for palatal malignancies with temporalis muscle reconstruction.
OBJECTIVE
To evaluate the use of a combined lateral temporal fossa and intraoral approach to resect palatal carcinomas and the use of a temporalis myofascial flap for reconstruction.


METHODS
Retrospective chart review of a case series.


METHODS
Tertiary university referral hospital.


METHODS
Sixteen patients underwent a combined approach for resection of palatal carcinoma; 5 of the 16 were edentulous. Six types of tumors were treated: adenoid cystic carcinoma (3 patients), low-grade mucoepidermoid carcinoma (5 patients), squamous cell carcinoma (3 patients), polymorphous low-grade adenocarcinoma (2 patients), osteosarcoma (1 patient), ameloblastoma (1 patient), and hyalinizing clear cell carcinoma (1 patient).


METHODS
The postoperative diet, velum competence, flap viability, complications, and survival.


RESULTS
Fifteen (94%) of 16 patients were able to resume their preoperative diets. No velopharyngeal insufficiency was encountered. All flaps survived and none required repeated surgical intervention. Five patients developed serous otitis media and 2 patients required flap revision secondary to posterior choanal obstruction. One patient died of complications unrelated to the procedure.


CONCLUSIONS
A combined intraoral and lateral temporal fossa approach allows for (1) en bloc resection of palatal malignancies along with resection of involved pterygoid muscles, (2) isolation and resection of descending palatine nerves and the proximal second division of the trigeminal nerve, and (3) primary reconstruction of the palatal defect by means of the temporalis muscle rotated into the operative defect. This method is especially useful in treating patients with perineural spread of palatal carcinoma, and in those who are edentulous.
Browne
J Dale
JD
Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1034, USA. jdbrowne@wfubmc.edu
Holland
Bradford W
BW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010157:Palatal Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps; D013703:Temporal Muscle / Q000637:transplantation*; D016896:Treatment Outcome