Functional Outcomes of the Retromaxillary-Infratemporal Fossa Dissection for Advanced Head and Neck/Skull Base Lesions

ABSTRACT

The retromaxillary-infratemporal fossa (RM-ITF) dissection, using a preauricular incision, was initially popularized for the treatment of temporomandibular joint disorders, facial fractures, and orbital tumors. This approach has been expanded for the treatment of advanced head and neck and skull base tumors extending into the infratemporal fossa. We studied prospectively eight consecutive patients requiring a RM-ITF dissection. Pre- and postoperative functional outcomes measured were mastication, speech, swallowing, cranial nerve function, pain, and cosmesis. A significant reduction in pain was noted postoperatively in all patients studied. Limited changes were identified in mastication, speech, swallowing, vision, hearing, or cosmesis postoperatively. The RM-ITF dissection should be considered when resecting advanced head and neck/skull base lesions that extend into this region. We have found minimal morbidity associated with this dissection. This procedure may have a useful place in palliation of patients with incurable pain caused by tumor invasion into the infratemporal fossa.

REFERENCES

• 1 Irish J C, Gullane P J, Gentili F. Tumors of the skull base: outcome and survival analysis of 77 cases.  Head Neck . 1994;  16 3-10
• 2 Osguthorpe J D. Sinus neoplasia.  Arch Otolaryngol Head Neck Surg . 1994;  120 19-25
• 3 Nuss D W, Janecka I P. Current indications for skull base surgery.  Arch Otolaryngol Head Neck Surg . 1992;  6 63-91
• 4 McCaffrey T V, Olsen K D, Yohanan J M. Factors affecting survival of patients with tumors of the anterior skull base.  Laryngoscope . 1994;  104 940-945
• 5 Leonetti J P, Al-Mefty O, Eisenbies J F. Orbitocranial exposure in the management of infratemporal fossa tumors.  Otolaryngol Head Neck Surg . 1993;  109 769-773
• 6 Zhang M, Garvis W, Linder T. Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma.  Laryngoscope . 1998;  108 1717-1723
• 7 Fagan J J, Snyderman C H, Carrau R L. Nasopharyngeal angiofibromas: selecting a surgical approach.  Head Neck . 1997;  19 391-399
• 8 Conley J J. The surgical approach to the pterygoid area.  Ann Surg . 1956;  144 39
• 9 Fisch U. Infratemporal fossa approach for extensive tumors of the temporal bone and base of the skull. In: Silverstein H, Norell H, eds. Neurological Surgery of the Ear Birmingham, AL: Aesculapius, 1977: 34-53
• 10 Fisch U. The infratemporal fossa approach for nasopharyngeal tumors.  Laryngoscope . 1983;  93 36-44
• 11 Conley J J. Changes in Diagnosis.  Stuttgart: Thieme, 1975: 85
• 12 Crockett D J. Surgical approach to the back of the maxilla.  Br J Surg . 1963;  50 819
• 13 Samy L L, Girgis J H. Transzygomatic approach for nasopharyngeal fibromata with extrapharyngeal extension.  J Laryngol . 1965;  79 782
• 14 Baumann R R. Der transorale/transartikulare Zugang zur Ausraumung des retromaxillaren Raumes. In: Kellerhals B, ed. Aktuelle Probleme der Otorhinolaryngologie Bern: Huber, 1977: 7-15
• 15 Obwegeser H L. Temporal approach to the TM-joint, to the orbit and to the retromaxillary space. In: Abstracts of the 4th Congress of the European Association for Maxillo-Facial Surgery, Venice, 1978: 46
• 16 Obwegeser H L. Temporal approach to the TMJ, the orbit, and the retromaxillary-infracranial region.  Head Neck Surg . 1985;  7 185-199
• 17 Wetmore S J, Suen J Y, Snyderman N L. Preauricular approach to infratemporal fossa.  Head Neck Surg . 1986;  9 93-103
• 18 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg . 1985;  93 146-147
• 19 Mann W J, Gilsbach J, Seeger W, Floel H. Use of malar bone graft to augment skull-base access.  Arch Otolaryngol . 1985;  111 30-33
• 20 Fisch U, Fagan P, Valavanis A. The infratemporal fossa approach for the lateral skull base.  Otolaryngol Clin North Am . 1984;  17 513-552
• 21 Throckmorton G S, Talwar R M, Ellis III E. Changes in masticatory patterns after bilateral fracture of the mandibular condylar process.  J Oral Maxillofac Surg . 1999;  57 500-508
• 22 Palmieri C, Ellis III E, Throckmorton G. Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures.  J Oral Maxillofac Surg . 1999;  57 764-775