Maxillary Swing Approach for Removal of Palatal Carcinoma: A Modified Procedure.

Tsutomu Nomura,Megumi Kishimoto,Seiji Kishimoto,Hirohisa Iwaki,Atsushi Ochi

doi:10.1155/2018/5318207

Abstract

Introduction We report a modification of the maxillary swing approach to remove a palatal tumor while preserving the anterior alveolar area. Methods Case report using clinical records. Results The patient was a 54-year-old male. TNM grade was T4bN0M0, and invasion to the base of the pterygoid process was seen. Two courses of induction chemotherapy were administered prior to the operation. Because there was no evidence of anterior maxillary invasion, the maxillary swing approach was chosen. The left anterior maxilla was cut and swung laterally, preserving the blood supply. After removal of the palatal tumor, the maxilla was repositioned and the defect was restored with an anterior lateral thigh flap. Postoperative course was typical, and facial appearance, speech, and masticatory function were satisfactory. Conclusions This technique is particularly useful for preserving appearance as well as speech and mastication.

Highlights

We report a modification of the maxillary swing approach to remove a palatal tumor while preserving the anterior alveolar area
A 54-year-old man who had complained of ongoing pain in the palate was referred to our department with a diagnosis of a palatal squamous cell carcinoma. e stage T4bN0M0 tumor had formed an ulcer in the palate and invaded the posterior portion of the inferior nasal turbinate. e pharyngeal orifice of the auditory tube was intact (Figure 1)
Because there was no evidence of anterior maxillary invasion, the maxillary swing approach was chosen. e surgical technique was as follows: a skin incision was made along the Weber–Fergusson incision, as in the original maxillary swing technique, and widened minimally to enable osteotomy

Summary

Introduction

In surgical treatment for tumors invading to the pterygoid fossa, complete resection with adequate surgical margins is challenging because of the anatomic complexity of the maxillofacial region. To overcome this issue, Wei et al [1] developed the maxillary swing (MS) approach to the nasopharyngeal area; this was later modified by Sumi et al [2] into the partial maxillary swing approach. A further modified version of the technique was reported by Shimoda et al [3]. We used an anteriorly modified form of MS to preserve the anterior alveolar area while removing a palate tumor invading the pterygoid lesion

Case Report

Discussion