Management of an Extended Parotid Gland Carcinoma Reaching the Skull Base

• Main Authors: Voss, Pit J, Metzger, Marc C, Schulze, Dirk, Weyer, Nils, Gutwald, Ralf, Schmelzeisen, Rainer
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2007-984262

Purpose: Parotid gland carcinomas are rare and symptoms mostly unspecific. In the presented case, a 53-year-old male patient with a low differentiated epithelial-myoepithelial carcinoma of the parotid gland was treated over a period of several months by the referring practitioner for symptoms of a myoarthropathy. Presenting in our department he showed malocclusion, reduced mouth opening, and a minor swelling of the right TMJ region. In the panoramic radiography a diffuse illumination of the right ascending ramus could be observed, which presented itself as a 5 × 5 × 4 cm tumor in the MRI, destroying the condyle and infiltrating the skull base. Method: For preoperative planning, a high-resolution CT scan with a navigation splint was made. The CT data were fused with data from the MRI and the tumor was marked using navigation software (VoXim, IVS−Solutions, Chemnitz, Germany). Intraoperatively, the navigation system was applied to localize the resection lines of the tumor and lymph node metastases located near the skull base. Monitoring of the facial nerve helped to identify the branches for a temporary transection. After resection of the ascending ramus, a reconstruction plate with an artificial condyle was inserted and reanastomosis of the facial nerve was performed. Result: Even though only an R1-situation could be achieved, 12 months after surgery and combined radiochemotherapy there is no sign of a new or residual tumor mass. Recovery from the temporary facial paresis occurred within the expectations and hasn't determined a diminution in the patient's life quality, according to his own reports. Conclusion: Fusion of MRI and CT data sets for computer-assisted surgery has shown to be extremely helpful in the resection of expanded soft-tissue carcinomas of the skull base. The further development of this technique can represent enormous progress in all medical areas, with a potential benefit in the prognosis of oncologic diseases. In the presented case a regeneration of the facial nerve after temporary transection could be seen even though a combined radiochemotherapy had been carried out.