Infratemporal Fossa and Lateral Skull Base Dissection: Long‐Term Results

Abstract

In 1981, we described a new surgical technique featuring en bloc removal of infratemporal fossa malignancies. This approach offered a systematic resection of cancers in this region and was designated "stylohamular dissection" because the medial boundary of the bloc is surgical plane between the styloid process and the hamulus of the pterygoid. All structures lateral to this plane are removed, sparing the internal carotid artery. Since 1977, twenty infratemporal fossa and lateral skull base dissections have been performed for palliation of metastatic or recurrent disease in the infratemporal fossa. Most patients obtained palliation of trismus, facial pain, or relief from an unmanageable ulcerating lesion. This technique offers improved average disease-free intervals, as well as enhanced survival rates compared to non-en bloc resections. A summary of the case presentations, survival statistics, and surgical technique with detailed cadaver dissections are presented.

Malignant Tumors of the Anterolateral Skull Base

“…3,7,20 The ITF may be unfamiliar to many neurosurgeons, although its anatomy has been well described. 4,19,21,22 Its contents include the medial and lateral pterygoid muscles, inferior portion of the temporalis muscle, internal maxillary artery, pterygoid venous plexus, otic ganglion, and branches of the mandibular (V3) and maxillary (V2) segments of the trigeminal nerve. Thus, neoplasms invading the ITF commonly present with facial pain due to involvement or compression of these nerves.…”

Infratemporal approaches to nasopharyngeal tumors

“…Therefore, transmandibular approaches with [9] or without [7] mandibulec-tomy are required when tumors of the tonsillar region extend into the infratemporal fossa or when nasopharyngeal carcinomas extend into the tonsillar region. The access obtained by anterior approaches is compromised by the long working distance required and is limited laterally in large tumors.…”

“…These include the subtemporal-preauricular infratemporal fossa approach [10], the subtemporal approach with facial translocation [6], various infratemporal approaches of type C [1,2], maxillary swings [4], and the transmandibular approach [7,9]. These include the subtemporal-preauricular infratemporal fossa approach [10], the subtemporal approach with facial translocation [6], various infratemporal approaches of type C [1,2], maxillary swings [4], and the transmandibular approach [7,9].…”