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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2009 Aprile;20(1):41-5
Surgical treatment of the infratemporal fossa neoplasms: our experience
Battisti A., Cassoni A., Aboh I. V., Priore P., Terenzi V., Anelli A., Valentini V.
Department of Maxillo-Facial Surgery “Sapienza Università di Roma” Polyclinic “Umberto I”, Rome, Italy
Aim. The infratemporal fossa is an anatomical space that presents a formidable challenge to the surgeon. Tumors involving this area pose difficulties in both their preoperative diagnosis and their surgical treatment. The infratemporal fossa can be compared to a quadrangular pyramid with upper base and lower apex in which muscular, vascular and neural tissues, in conjunction with fat tissue and lymphatics, are contained. We have reviewed all surgical approaches to the IF found in literature and analyzed our 22 years experience at the Department of Maxillo-Facial Surgery, Policlinico Umberto I of Rome, in order to select the most suitable technique.
Methods. Sixty-four neoplastic cases (36 females [56.25%]; 28 males [43.75%] ; years range 1-78) have been reported primarily or secondarily involving the IF. 55 patients were surgically treated, 7 (13%) have been treated using a single, trans-maxillary approach, 3 (6%) performing a single anterior trans-mandibular technique, 25 (46%) with a single lateral trans-mandibular approach, 1(2%) using a single trans-maxillary/anterior trans-mandibular approach, whereas 12 (22%) have been treated using a combined trans-maxillary/lateral trans-mandibular approach. Trans-cranio-facial surgery has been performed in 7 (13%) cases.
Results and conclusion. The surgical approach must be evaluated according to the nature, size and extent of infiltration, in order to achieve a radical, “en-bloc” excision of the neoplasm. Among the single transfacial approaches, the authors believe the lateral one to be more effective (because it gives the surgeon a better view of the area as well as the possibility to perform a latero-cervical lymph-node excision at the same time of the tumorectomy) compared to the anterior, either trans-maxillary or anterior trans-mandibular, which does not allow complete control over the infratemporal region.