title: Osteotomy in the vertical ramus outside the mandibular foramen for tumours in the parapharyngeal space.
abstract: BACKGROUND
  Although several techniques have been described to access the parapharyngeal space, tumour surgery in this area remains a challenge. This study investigated a simple and safe technique to access parapharyngeal space tumours.
  
  
  METHODS
  Eight primary parapharyngeal space tumours were treated with osteotomy of the vertical ramus outside the mandibular foramen. The primary tumours were pleomorphic adenoma, schwannoma, Warthin's tumour, lipoma, chordoma, and adenoid cystic carcinoma. Tumour size ranged from 4 × 4 cm to 6 × 7 cm. Patients with malignant tumours who underwent surgical resection also received adjuvant dose-fractionated stereotactic radiotherapy.
  
  
  RESULTS
  All tumours were removed completely without rupture. No patient exhibited any permanent postoperative complication, malocclusion, or other dental complications from this surgical approach. One patient had slight transient postoperative facial paresis, which resolved spontaneously within 4 weeks. The patients were followed for 7-26 months, during which no recurrence was encountered.
  
  
  CONCLUSIONS
  Osteotomy of the vertical ramus outside the mandibular foramen achieved good exposure and satisfactory aesthetic and functional results. This simple and safe technique facilitates the removal of infratemporal fossa tumours while preserving the inferior alveolar nerve.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China. Electronic address: drchen@vip.163.com.
authors.forename: Wei-liang
authors.initials: WL
authors.lastname: Chen
authors.affiliation: Department of Oral and Maxillofacial Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510100, China.
authors.forename: Wei-jian
authors.initials: WJ
authors.lastname: Wang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
authors.forename: Zhi-quan
authors.initials: ZQ
authors.lastname: Huang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
authors.forename: Da-ming
authors.initials: DM
authors.lastname: Zhang
mesh_terms: D000235:Adenolymphoma / Q000601:surgery; D008949:Adenoma, Pleomorphic / Q000601:surgery; D000328:Adult; D001860:Bone Plates; D003528:Carcinoma, Adenoid Cystic / Q000601:surgery; D002817:Chordoma / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005158:Facial Paralysis / Q000209:etiology; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008067:Lipoma / Q000601:surgery; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D010614:Pharynx; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D012468:Salivary Gland Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Infratemporal fossa; Osteotomy; Parapharyngeal space; Skull base; Tumour