OP223: Osteotomy in the vertical ramus of the mandibular foraman for tumors in the infratemporal fossa

Abstract

Background Although several techniques have been described for to access to infratemporal fossa, surgical managements of the parapharyngeal space tumors remains a challenge. Objectives This study investigated a simple and safe technique being used to access to infratemporal fossa tumors. Material and methods Between January 2010 to January 2012, eight patients with primary infratemporal fossa tumors (two schwannomas, two pleomorphic adenoma, one Warthin’s tumor, one lipoma, one chordoma and one adenoid cystic carcinoma) were treated with an approach of osteotomy in the vertical ramus outside the mandibular foraman at the Department of Oral and Maxillofacial Surgery, the Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. This study was approved by the institutional review board. Of the eight patients, six were male and two were female. The mean age was 42.4 months (range 19–62 years). The diagnoses were based on the clinical history, physical examination and instrumental (computed tomography or magnetic resonance imaging) assessment (Fig. 1) and confirmed by permanent pathologic sections. Primary sites of the lesions were the infratemporal fossa pleomorphic adenoma (2), schwannomas (two cases), Warthin’s tumor (1), lipoma (1), chordoma adenoid cystic carcinoma (1) and adenoid cystic carcinoma (1). The sizes of the tumors varied from a minimum of 4 cm × 4 cm to a maximum of 6 × 7 cm, median 5.0 × 5.5 cm. Infratemporal fossa malignant tumors patients who underwent surgical resection received adjuvant 48.6 Gy in total of dose fractionated stereotactic radiotherapy. Results All of the tumors were removed completely and without rupture. No patient exhibited any permanent postoperative complication. Neither patient had malocclusion or other dental complications from the approach. One patient had slight transient postoperative facial paresis, which resolved spontaneously within 4 weeks. The patients were followed for 7–26 months (average, 17 months). No recurrence was encountered. Conclusion This simple, safe technique can be used to access to infratemporal fossa tumors while preserving the inferior alveolar nerve.