title: Anterolateral corridor approach to the infratemporal fossa and central skull base in maxillectomy: rationale and technical aspects.
abstract: We describe the technical aspects and report our clinical experience of a surgical approach to the infratemporal fossa that aims to reduce local recurrence after operations for cancer of the posterior maxilla. We tested the technique by operating on 3 cadavers and then used the approach in 16 patients who had posterolateral maxillectomy for disease that arose on the maxillary alveolus or junction of the hard and soft palate (maxillary group), and in 19 who had resection of the masticatory compartment and central skull base for advanced sinonasal cancer (sinonasal group). Early proximal ligation of the maxillary artery was achieved in all but one of the 35 patients. Access to the infratemporal fossa enabled division of the pterygoid muscles and pterygoid processes under direct vision in all cases. No patient in the maxillary group had local recurrence at median follow up of 36 months. Four patients (21%) in the sinonasal group had local recurrence at median follow up of 27 months. Secondary haemorrhage from the cavernous segment of the internal carotid artery resulted in the only perioperative death. The anterolateral corridor approach enables controlled resection of tumours that extend into the masticatory compartment.
authors.affiliation: Consultant Maxillofacial Head Neck Surgeon, Southern General Hospital, Glasgow G514TF, UK. Electronic address: jeremymcmahon@nhs.net.uk.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: McMahon
authors.affiliation: Consultant ENT Skull Base Surgeon, Southern General Hospital, Glasgow G514TF, UK.
authors.forename: John
authors.initials: J
authors.lastname: Crowther
authors.affiliation: Consultant Neurosurgeon, Southern General Hospital, Glasgow G514TF, UK.
authors.forename: William M
authors.initials: WM
authors.lastname: Taylor
authors.affiliation: Oral and Maxillofacial Surgeon, Hospital Sibu, Sarawak, Malaysia.
authors.forename: Ling Siew
authors.initials: LS
authors.lastname: Wong
authors.affiliation: Core Surgical Trainee, Portsmouth Hospital, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Paterson
authors.affiliation: Consultant Maxillofacial head Neck Surgeon, Southern General Hospital, Glasgow G514TF, UK.
authors.forename: John
authors.initials: J
authors.lastname: Devine
authors.affiliation: Consultant Maxillofacial head Neck Surgeon, Southern General Hospital, Glasgow G514TF, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Wales
authors.affiliation: Consultant Maxillofacial head Neck Surgeon, Southern General Hospital, Glasgow G514TF, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: MacIver
mesh_terms: D006257:Head; D006801:Humans; D008437:Maxilla; D009364:Neoplasm Recurrence, Local; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms
keywords: Infratemporal fossa; Maxillary Cancer; Maxillectomy; Sinonasal Cancer; Skull Base Surgery; Squamous Cell Carcinoma