title: Microsurgical anatomy of subtotal temporal bone resection en bloc with the parotid gland and temporomandibular joint.
abstract: BACKGROUND
  Subtotal temporal bone resection (STBR) has been used for half a century to remove temporal bone malignancies. However, there are few reports on the detailed anatomy involved in the resection.
  
  
  OBJECTIVE
  To describe the microsurgical anatomy of STBR combined en bloc with the resection of the parotid gland and temporomandibular joint (TMJ).
  
  
  METHODS
  Cadaveric specimens were dissected in a stepwise manner using 3× to 40× magnification.
  
  
  RESULTS
  STBR can be combined with the total parotidectomy and the resection of the TMJ if the tumor extends into the parotid gland, TMJ, or facial nerve. In this study, we describe the step-by-step microsurgical anatomy of STBR en bloc with the parotid gland and TMJ. The surgical technique described combines 3 approaches: the high cervical, subtemporal-infratemporal fossa, and retromastoid-paracondylar approaches. Combining these 3 approaches aided in efficiently completing this modified approach.
  
  
  CONCLUSIONS
  STBR is a complicated and technically challenging procedure. This study highlights the importance of understanding the surgical anatomy of STBR and will serve as a catalyst for improvement of the surgical technique for temporal bone resection.
authors.affiliation: *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Otorhinolaryngology Head and Neck Surgery, Kyushu University, Fukuoka, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Komune
authors.forename: Shizuo
authors.initials: S
authors.lastname: Komune
authors.forename: Takashi
authors.initials: T
authors.lastname: Morishita
authors.forename: Albert L
authors.initials: AL
authors.lastname: Rhoton
mesh_terms: D002102:Cadaver; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D010306:Parotid Gland / Q000033:anatomy & histology*; D013702:Temporal Lobe / Q000033:anatomy & histology* / Q000601:surgery*; D013704:Temporomandibular Joint / Q000033:anatomy & histology*