Transcervical Double Mandibular Osteotomy Approach to the Infratemporal Fossa

Abstract

In this study, we propose an alternative to the traditional transmandibular lower lip and chin splitting approach for exposing high infratemporal fossa and parapharyngeal space lesions involving the carotid canal and jugular foramen. We present 2 cases of high skull base tumors removed transcervically with anterior and posterior segmental mandibulotomies preserving the mental nerve without the use of a lip or chin incision. Making the posterior osteotomy in an inverted L configuration is necessary so that the coronoid process does not prevent rotation of the mandible out of the visual field. Both patients had complete tumor resection with access to the carotid canal and jugular foramen and functional preservation of the mental nerve and marginal branch of the facial nerve. Neither patient had malocclusion or other dental complications from the approach. This novel technique is useful for providing excellent access to high infratemporal fossa or parapharyngeal space tumors. It avoids the traditional chin or lip incision and preserves the mental and facial nerves and is a useful procedure in the armamentarium of skull base/cerebrovascular neurosurgeons.