Partial Maxillectomy Research Articles

Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors

Introduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull base; normal symmetry; good aesthetic result.Materials and methods. Between 2014 and 2020, we followed up 13 patients. Nine of them (69 %) had combined defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010), as well as skin on the buccal and zygomatic areas; 1 patient also had lower eyelid affected. Four individuals (31 %) had isolated defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010). Twelve patients have undergone preoperative 3D-computer simulation. We divided patients into 2 groups according to the size of their defects and resection areas in the anterior wall of the maxillary sinus. Group 1 included 5 patients with partial maxillary defects (involving 25–40 % of the total area), whereas Group 2 comprised 7 patients with limited maxillary defects (involving 25–40 % of the total area).Five patients have undergone reconstructive surgeries with fasciocutaneous flaps, including anterolateral thigh flaps used in 4 individuals (31 %) and thoracodorsal flap used in 1 individual (8 %). Eight patients had their defects repaired using radial fasciocutaneous flaps. The inferior orbital wall was reconstructed using an individual titanium mesh implant.Results. All patients from Group 1 after defect repair with anterolateral thigh flaps and thoracodorsal flaps (4 individuals) had satisfactory aesthetic result. One patient had an unsatisfactory aesthetic result after reconstruction with a radial fasciocutaneous flap due to mesh implant protrusion and formation of an opening in the nasal cavity. The assessment of the eyeball position demonstrated that symmetry was achieved in 4 patients (80 %) after reconstruction using anterolateral thigh flaps (3 patients) and thoracodorsal flap (1 patient). Five patients from Group 2 (72 %) had excellent results, while 2 patients (28 %) had satisfactory results. The assessment of the eyeball position demonstrated that symmetry was achieved in 5 patients (70 %); two participants (28 %) had lower eyelid ectropion.Conclusion. Patients with large maxillary defects (involving 41–60 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) should undergo reconstructive surgeries with fasciocutaneous anterolateral thigh flaps. In case of relatively small defects (involving 25–40 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) the best option is defect repair with radial fasciocutaneous flaps. Such strategy ensures excellent aesthetic and functional results in 75 % of patients.

Two-piece hollow bulb obturator after partial maxillectomy on ameloblastoma case

Ameloblastoma often occurs in the mandibular area, but 15 - 20% of ameloblastoma originates from the maxilla. Ameloblastoma lesions in the maxilla can be treated with partial maxillectomy, which produces defects that alter speech, swallowing function, and aesthetic. The role of prosthodontics is needed to rehabilitate the patient’s condition by fabricating an obturator that helps reduce the morbidity of patients. The main problem with the rehabilitation of substantial defects in the maxilla is the weight of the prosthesis, resulting in non-retentive prosthesis. The purpose of this case report was to evaluate the post-treatment of the partial maxillectomy in the case of ameloblastoma with the hollow bulb to rehabilitate the functions of mastication, phonetics, swallowing function, and aesthetic functions.This case report discussed the treatment of a 58-year-old female who undergone partial maxillectomy, has experienced tooth loss in 15, 14, 13, 12, 11, 21, 22, and 23, and had an anterior palate defect due to mass retrieval under the Aramany class VI classification. The chosen treatment was the fabrication of an obturator with the twopiece hollow bulbmade of acrylic resin. The results of the obturator insertion are good retention, stabilization,occlusion, aesthetics, clear phonetic, and the increasing patient’s confidence. The follow-up control after one week showed good retention, stabilization, occlusion, aesthetics, even clearer pronunciation and a good adaptation from the patient. This case report concludes that the two-piece hollow bulb acrylic resin obturator in ameloblastoma case can rehabilitate the maxillary defect post partial maxillectomy to restore masticatory, phonetic, swallowing and aesthetic functions.

Partial Maxillectomy for the Improvement of Nasal Obstruction Can Be Combined with Septorhinoplasty.

We describe the (anteromedial) partial maxillectomy technique which can be used to address impaired nasal breathing in cases of significant protrusion of the frontal process of the maxilla into the nasal cavity, narrowing the nasal pathway. It fits to nasal physiology avoiding mucosal resection. It can be combined with surgery of the inferior turbinate. The described technique can be used in all forms of rhinoplasty.

Effect of the surgical treatment of maxillary medication-related osteonecrosis of the jaw

Objective: To explore the methods and clinical effects of the surgery for treating maxillary medication-related osteonecrosis of the jaw (MRONJ). Methods: The clinical data including gender, age, stage of lesion, treatment method and prognosis of 28 patients with maxillary MRONJ who underwent surgical treatment in the Department of Oral and Maxillofacial Surgery of Medical School of Nanjing University from January 2013 to October 2020 were retrospectively analyzed. There were 20 males and 8 females. The mean age at onset was (65.6±11.1) years old. According to the guidelines of American Association of Oral and Maxillofacial Surgeons, the patients' lesions were divided into 2 or 3 stages. Ten cases of stage 2 lesions were tightly sutured after partial jaw resection. Among them, 4 lesions were sutured directly with mucoperiosteal flaps, 4 lesions were covered by adjacent flaps and 2 lesions was covered by buccal fat pad flaps and adjacent flaps. Eighteen cases of stage 3 lesions were treated with sequestrectomy and drainage channels were formed. Patients were followed up regularly after the surgery, and the effect of surgical treatment was judged according to the clinical criteria such as clinical manifestations, local oral examination, imaging examination etc. Results: After follow-up for 12 to 52 months, the postoperative pain score (1.20±2.53) was significantly lower than preoperative pain score (6.70±0.95) (P<0.05) in stage 2 patients. Eight patients' mucosa healed completely without new dead bone formed. Two patients had recurrence and developed to stage 3 at the time of revisit. There were 18 cases of stage 3 lesions, which formed drainage channels after removal of the dead bone. The postoperative follow-up time was 2 to 67 months, and the symptoms of inflammation and infection disappeared. Postoperative pain score (3.40±0.51) was significantly lower than preoperative pain score (7.06±1.00) (P<0.05). Conclusions: Soft tissue flap closure of wound after partial maxillectomy is an effective approach for the treatment of maxillary MRONJ stage 2 lesions, while maxillary stage 3 lesions could be treated for eliminating clinical symptoms and improving the quality of life when establishing unobstructed drainage after dead bone extraction.

A case of malignant melanoma mixed with a cervical lymph node metastatic lesion of undifferentiated cancer occurring in the maxillary gingiva

The histopathology of metastatic lesions are usually the same as primary lesions in malignant tumors. We report a rare case of malignant melanoma that was mixed with a cervical lymph node metastatic lesion of undifferentiated cancer occurring in the maxillary gingiva. The patient was referred to our department because of pain in the area of the maxillary anterior teeth. After confirmation of undifferentiated cancer by biopsy, a right partial maxillectomy and extended supraomohyoid neck dissection were performed. Histopathological examination revealed that the primary lesion was undifferentiated cancer and the metastatic lesion was malignant melanoma. We suggested the possibility that a malignant melanoma of unknown primary origin and the undifferentiated cancer in the maxillary gingiva metastasized to the same cervical lymph node as a collision tumor.

Association of Virtual Surgical Planning With External Incisions in Complex Maxillectomy Reconstruction

Maxillectomy can commonly be performed through a transoral approach, but maxillectomy defect reconstruction can be difficult to precisely design, contour, and inset through this approach. To evaluate whether the use of virtual surgical planning (VSP) and 3-dimensional (3-D) modeling is associated with a decrease in the requirement of lateral rhinotomy (LR) for patients undergoing total and partial maxillectomy reconstruction. This retrospective cohort study was conducted among patients undergoing subtotal or total maxillectomy with microvascular free flap reconstruction with or without VSP and 3-D modeling at a single tertiary care academic medical center between January 1, 2008, and October 3, 2019. Maxillectomy and free flap reconstruction with or without VSP. Necessity of LR or other external incision for contouring, placement, and fixation of reconstruction as well as surgical complications. Fifteen patients (12 men [80%]; mean age, 64 years) underwent maxillectomy with free flap reconstruction without VSP. Eight patients (53%) in this group underwent total maxillectomy, and 4 patients in this group (27%) underwent partial maxillectomy. Twenty-three patients (18 men [78%]; mean age, 58 years) underwent maxillectomy with free flap reconstruction and VSP and 3-D modeling. Twelve of these patients (52%) underwent total maxillectomy, and 11 (48%) underwent partial maxillectomy. Lateral rhinotomy was necessary for 1 patient (4%) in the VSP group vs 12 patients (80%; 95% CI, 54%-98%) in the pre-VSP group. There were no LR complications in the VSP group vs 6 in the pre-VSP group. Among both groups, 14 patients underwent fibula free flap, 22 patients underwent subscapular system free flap, and 2 patients underwent cutaneous or osteocutaneous radial forearm free flap. There were no flap failures in the LR group and 1 flap failure in the group without LR. This cohort study suggests that the use of VSP and 3-D modeling for maxillectomy reconstruction is associated the a decrease in the need for external incisions without compromising reconstructive flap utility.

Survival time of juvenile dogs with oral squamous cell carcinoma treated with surgery alone: A Veterinary Society of Surgical Oncology retrospective study.

To report the signalment, staging, surgical treatment, and survival time of juvenile dogs treated surgically for oral squamous cell carcinoma (OSCC). Retrospective study. Twenty-five dogs, <2 years of age with OSCC treated with surgery. Cases were solicited from the Veterinary Society of Surgical Oncology. Data retrieved included sex, breed, age, weight, clinical signs, tumor location, preoperative diagnostics and staging, histopathological diagnosis with margin evaluation, disease-free interval, and date and cause of death. A minimum follow-up time of 3 months was required for inclusion. Eighteen dogs were <12 months of age, and seven were <24 months. Various breeds were represented, with a mean body weight of 22.3 ± 14.4 kg. No dogs had evidence of metastatic disease prior to surgery. All dogs underwent partial maxillectomy or mandibulectomy. Histological margins were complete in 24 dogs and incomplete in one. No dogs had evidence of metastatic disease or tumor recurrence. The median follow-up time was 1556 days (92 to 4234 days). All dogs were alive at the last follow-up except for one documented death, due to dilated cardiomyopathy. Median disease-specific survival time was not reached. The prognosis after wide surgical excision of OSCC in juvenile dogs was excellent. OSCC in juvenile dogs can be effectively treated with surgery alone.

Mucormycosis originated total maxillary and cranial base osteonecrosis: a possible misdiagnosis to malignancy

BackgroundThis is a case of mucormycosis originated osteonecrosis of the maxilla extended to the cranial base, initially suspected of malignancy. The patient was first suspected with osteolytic sarcomatous lesion but was later diagnosed with total maxillary necrosis and cranial base through biopsy-proven invasive mucormycosis.Case presentationA 71-year-old male was presented with unknown total maxillary osteonecrosis. CT and MRI results showed extensive osteolytic change with bone destruction of the cranial base, and PET-CT showed irregular hypermetabolic lesion in the area suspected of malignancy. The first biopsy results only presented tissue inflammation. Thus, several further endoscopic biopsy were performed through posterior pharyngeal wall. The patient was eventually diagnosed with mucormycosis and associated osteomyelitis with subsequent bone necrosis. With confirmed diagnosis, partial maxillectomy of the necrosed bone was performed under general anesthesia. At the 4 week follow-up, the patient showed full mucosal healing and no recurrence or aggravation of the maxilla and cranial base lesion was observed.ConclusionsAccurate diagnosis of atypical symptoms, timely diagnosis, and proper combination therapy of surgical intervention, antifungal agent, and antibiotic use for skull base osteomyelitis are all critical for proper treatment planning. In addition, biopsy and CT scans are essential in differentiating osteonecrosis from malignancy.

Unanticipated Intraoperative Airway Emergency Due to Near-Total Transection of Endotracheal Tube during Partial Maxillectomy

Endotracheal tube (ETT) damage during head and neck surgeries is an uncommon complication needing quick corrective action to avoid hypoxia and aspiration of blood into lungs. Our case illustrates an unanticipated complication created during partial maxillectomy by a reciprocating motor saw. Accidental near-total transection of ETT was successfully managed by a novel technique of reintubation guided by an airway exchange catheter placed alongside the damaged ETT.

A method of hollowing the obturator prosthesis and an overview on the pros and cons of the various materials used for hollowing.

Prosthetic rehabilitation of a partial or total maxillectomy with an obturator is the most acceptable treatment option. The hollowing of the obturator prosthesis is beneficial as it reduces the stresses over the underlying and surrounding tissues. A simple technique of fabricating a hollow bulb obturator has been discussed in this article. At the step of the packing of a denture, the hollow wax pattern of the defect area is formed with modeling wax. This hollow wax pattern is filled with water and is allowed to freeze to form an ice block. This ice block is removed from the wax pattern and is interposed between two layers for heat-cured acrylic resin and is then cured. After processing the denture, the water is retrieved by making a small hole in denture base, which is packed after hollowing with a cold cure acrylic resin. A lightweight prosthesis with a uniform thickness was achieved with a readily available and easily retrievable material, i.e., ice.

Spindle Cell Sinonasal Rhabdomyosarcoma in a 73-Year-Old Man: A Case Report

Introduction Rhabdomyosarcoma (RMS) is a malignant soft tissue neoplasm differentiating into primitive mesenchymal cells with partial skeletal muscle differentiation. It is rare, especially in the sinonasal cavity. We review available literature on sinonasal RMS and present a case report involving spindle cell sinonasal RMS, one of the rarest subtypes. Case Report A 73-year-old man with months of right-sided epiphora and nasal obstruction had abnormal soft tissue and calcification in the right nasal cavity on computed tomography. Nasal endoscopy revealed a smooth, firm mass involving the inferior turbinate. The mass was removed en bloc via endoscopic partial medial maxillectomy and ethmoidectomy. Gross pathologic examination revealed a mottled red, tan, firm, bosselated, and glistening mass, with irregular fragments of soft tissue and bone. Histologic examination showed a variably myxoid and fibrous neoplasm with hyalinization. Tumor cells were spindled with moderate pleomorphism and low mitotic activity. Immunohistochemistry was extensively positive for desmin and myoD1 and focally positive for smooth muscle actin. A diagnosis of sinonasal RMS, grade 2, was made. Discussion/Conclusion This is the first reported case of spindle cell RMS originating from the inferior turbinate. Sinonasal RMS has the worst prognosis of all primary sites, especially with age older than 65 years, alveolar subtype, primary tumor greater than 5 cm, high stage/group, and distant metastases. While the risk stratification system accounts for surgical and pathologic factors, more research is needed to determine how this guides selection of resection and/or chemoradiation.

Effect of submental flap reconstruction versus obturator rehabilitation after maxillectomy on quality of life: a randomized clinical trial

The surgical removal of a maxillary tumour will result in an oronasal communication, which can negatively affect the patient’s life and daily functions. Following maxillectomy, the defect can be treated with a prosthetic obturator or microvascular flap. However, the gold standard technique remains controversial. The aim of this study was to evaluate and compare quality of life (QoL) outcomes of submental island flap versus maxillary obturator reconstruction after partial maxillectomy. Sixty patients indicated for maxillectomy were allocated randomly to two equal-sized groups. Control group patients underwent reconstruction with a surgical obturator, while intervention group patients underwent submental island flap reconstruction. Patient QoL was evaluated at the 6-month follow-up using the University of Washington Quality of Life Questionnaire. Statistically significant differences in QoL were found between the two groups. Chewing (P = 0.034), swallowing (P < 0.001), speech (P = 0.009), taste (P = 0.04), mood (P = 0.01), and anxiety (P = 0.003) domains showed a statistically significant improvement in the submental group compared to the obturator group. However, the obturator group showed a greater improvement in appearance (P < 0.001). The masticatory function scores in the obturator group were significantly higher after obturator rehabilitation (P < 0.001). In conclusion, this study found that submental flap reconstruction provided better function and QoL than the obturator. This reconstruction was associated with less pain and better pronouncing of words, chewing, swallowing food, and psychosocial adjustment.

Application of additive and subtractive manufacturing technology for a digitally fabricated removable partial denture after a partial maxillectomy: A clinical report

This clinical report describes the treatment of a patient with a large defect area in the maxillary central incisor, left lateral incisor, canine, and first premolar area after a partial maxillectomy. Computer-aided design and computer-aided manufacturing (CAD-CAM) techniques including rapid prototyping and milling were applied together to fabricate a removable partial denture.

Cribriform Adenocarcinoma of the Minor Salivary Gland (CAMSG); A Separate and Malignant Entity

Abstract Introduction/Objective Cribriform adenocarcinoma of the minor salivary gland (CAMSG) is a recently described salivary gland neoplasm (SGN) that WHO includes under the polymorphous adenocarcinoma (PAC) subheading. CAMSG is reported to occur mostly in the base of the tongue and lingual tonsils. Methods We present a case of CAMSG of buccal mucosa in a 48-year old woman who presented with pain and swelling on the left side of the face that started after tooth extraction. Imaging revealed a large expansile mass (5.8 x 4.3 x 6.1 cm) originating in the left mandibular angle extending into masticator space, maxillary sinus, pterygopalatine fossa, sphenoid, middle cranial fossa, orbit and skull base. Ameloblastoma, primary intraosseous carcinoma, and squamous cell carcinoma were considered. Incisional biopsy revealed a tumor comprised of round to ovoid cells with clear to vesicular nuclei (ground-glass appearance) and occasional mitosis present in irregular solid, cribriform, and microcystic patterns in a hyalinized stroma with the presence of abundant mucin within lobules and stroma. Results Differential diagnosis of secretory carcinoma, hyalinizing clear cell carcinoma, and less likely PAC and mucoepidermoid carcinoma were considered, all inconsistent with the imaging findings. The tumor cells were positive for S100 and negative for CD117, ki67, p63, CD117, and TTF-1. Based on a prominent cribriform pattern, vesicular nuclei, and S-100 expression, a diagnosis of cribriform adenocarcinoma of minor salivary gland origin was rendered. The patient subsequently underwent left partial maxillectomy, left partial mandibulectomy, and resection of the skull base and left neck dissection and was staged as pT4bN0, with negative margins and vascular invasion. The patient underwent radiation therapy and at 6- month follow up was alive and healthy. Clinically and histologically CAMSG overlaps with tumors of both salivary and non-salivary gland origin. Conclusion Recognition of CAMSG as a distinct entity will help in accurate diagnosis and categorization in the WHO classification of SGNs.

Hollow bulb obturator and implant retained mandibular overdenture for a compromised completely edentulous patient with partial maxillectomy

A large maxillary defect situation is often challenging in terms of prosthetic rehabilitation considering the lack of retention, facial support and limited mouth opening along with psychological and functional trauma to the patient. In such situations we aim to successfully rehabilitate the defect in terms of function and aesthetics while ensuring complete obturation of the defect. A 65 years old female with maxillary surgical defect of right side due to squamous cell carcinoma resection along with associated limited mouth opening and post surgical scar contracture reported for prosthetic rehabilitation. This paper describes in detail an unconventional method for the fabrication of a modified hollow bulb obturator with an implant retained mandibular overdenture with monoplane occlusion and balancing ramps. This not only closed the oro-antral communication but also enhanced the masticatory performance, speech and psychological status of the patient. Decreased weight of the prosthesis and an implant retained mandibular overdenture with monoplane occlusion and balancing ramps improved retention, stability and support of the prosthesis, thereby, improving the quality of life after extensive maxillectomy.

PALATAL OBTURATORS PROSTHESIS AFTER MAXILLECTOMY: CHALLENGES AND REWARDS OF THE ORAL REHABILITATION

The surgical treatment of tumors in the maxilla can cause oroantral communication. Partial or total maxillectomy always impairs the most different degrees of functionality of the oral cavity. Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. Previous radiotherapy contraindicates dental implants, due to the risk of osteoradionecrosis. The morphologic and functional limitations resulting from the oncological surgery require careful, individualized, and integral planning. Rehabilitation of patients with maxillary defects using obturator prosthesis is an appropriate and not invasive treatment modality, allowing easy visualization of possible recurrence. The series of reported cases shows that palatal obturator rehabilitation improves patients’ quality of life, reestablishing the masticatory, phonetic, and aesthetic functions, reinserting the oncologic patient into the socio-affective environment with confidence and self-esteem. The surgical treatment of tumors in the maxilla can cause oroantral communication. Partial or total maxillectomy always impairs the most different degrees of functionality of the oral cavity. Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. Previous radiotherapy contraindicates dental implants, due to the risk of osteoradionecrosis. The morphologic and functional limitations resulting from the oncological surgery require careful, individualized, and integral planning. Rehabilitation of patients with maxillary defects using obturator prosthesis is an appropriate and not invasive treatment modality, allowing easy visualization of possible recurrence. The series of reported cases shows that palatal obturator rehabilitation improves patients’ quality of life, reestablishing the masticatory, phonetic, and aesthetic functions, reinserting the oncologic patient into the socio-affective environment with confidence and self-esteem.

ORAL SQUAMOUS CELL CARCINOMA PRESENTING AN UNUSUAL REGRESSION BEHAVIOR POST PARTUM

The incidence of oral squamous cell carcinoma (OSCC) in young and healthy patients has been described and represents only 2% of cancers during pregnancy, usually associated with worse outcome. A nonsmoking 31-year-old woman presented a painful nodular lesion at the hard palate, which overgrew during pregnancy and showed unexpected regression following childbirth. After 1 year the lesion presented as an indurated erythematous plaque with elevated borders at the hard palate expanding to the soft palate. An incisional biopsy specimen showed exuberant hyperplastic epithelium with keratin pearl formation, compatible with well-differentiated OSCC and positivity for p16. She underwent partial maxillectomy with a microvascular free flap reconstruction. Bone and lymph nodes were tumor free, and minor salivary glands were infiltrated. No adjuvant treatment was needed. We report a rare regression phenomenon of OSCC and pose a question whether pregnancy may have contributed to tumor regression, which could guide future therapeutic targets against cancer.

Second primary chondrosarcoma of the maxilla: a case report

&lt;p&gt;We are reporting an uncommon case of second primary chondrosarcoma of the maxilla in a 52-year-old male patient. Patient had first been diagnosed in 2004 with chondrosarcoma of the right maxilla. He had undergone right partial maxillectomy for the same. Since 2016 he had started noticing a swelling over the left side of the maxilla. Repeated biopsies from the growth showed no evidence of any malignancy. Hence, he was kept on routine follow up. However, in 2018, during follow up the growth had increased in size - hard swelling present in remnant post partial maxillectomy cavity, non-tender -and a punch biopsy was taken, revealing a well differentiated chondrosarcoma. A diagnosis of second primary chondrosarcoma of the maxilla was made based on Warren and Gates criteria. A brief discussion on the radiologic and histologic presentation of the tumor and the treatment modalities of this unusual tumor is discussed.&lt;/p&gt;

Treatment Outcomes for Primary Retromolar Trigone Carcinoma: A Single Institution Experience.

Retromolar trigone (RMT) is a rare location for oral cavity cancers. RMT cancers are aggressive malignancies that mostly present at an advanced stage. In this study, we aimed to evaluate treatment outcomes in patients who underwent initial radical surgical resection and postoperative radiotherapy or chemoradiotherapy with a diagnosis of primary RMT squamous cell carcinoma in our institution. The study included 20 primary RMT tumor patients out of 191 oral cavity cancer cases treated from January 2010 through December 2019. We retrospectively analyzed treatment details, histopathology reports, postoperative clinical course and survival outcomes. The mean age at presentation was 59.4 years. Eighty percent of all patients were either stage 3 or stage 4. We performed mandibular resection in 14 patients (70%) and partial maxillectomy in eight patients (40%). Nineteen patients (95%) underwent unilateral neck dissection. The incidence of metastatic cervical lymph node was 13/20 (65%). Overall survival (OS) and disease-free survival (DFS) rates during follow-up (mean 26.3 months) were 60% and 75%, respectively. There was statistical significance between presence of multilevel metastatic lymph nodes and OS (p=0.013). DFS and OS of early stage and advanced stage groups were 100% vs 75% and 100% vs 50%, respectively, with no statistical significance (p=0.189 and p=0.084). The survival of advanced stage RMT cancer is poor despite appropriate treatment. Bone involvement that necessitates resection is common due to the proximity of the tumor to the mandible and the maxilla. Multilevel positive cervical lymph nodes and advanced stage are poor prognostic factors.

Practical Guide for Identification of Internal Carotid Artery During Endoscopic Nasopharyngectomy.

View Supplementary Video 1 Laryngoscope, 2020