Successful management of recurrent adenoid cystic carcinoma in the deep infratemporal fossa by maxillo-orbito-zygomatic approach

In the case of deep invasion of an infratemporal fossa (ITF) tumor, surgeons find it difficult to gain sufficient visualization and working space by conventional surgical approaches. To overcome these limitations, we have developed a novel surgical technique, maxillo-orbito-zygomatic (MOZ) approach,...

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Bibliographic Details
Published in:Auris, nasus, larynx nasus, larynx, 2019-12, Vol.46 (6), p.921-926
Main Authors: Hongo, Takahiro, Fukushima, Junichi, Uchida, Yoshinori, Rikimaru, Fumihide, Toh, Satoshi, Higaki, Yuichiro, Masuda, Muneyuki
Format: Article
Language:English
Subjects:
Adenoid-cystic carcinoma
Carcinoma, Adenoid Cystic - surgery
Humans
Infratemporal fossa
Infratemporal Fossa - surgery
Male
Maxilla - surgery
Maxillo-orbito-zygomatic approach
Middle Aged
Middle skull base
Neoplasm Recurrence, Local - surgery
Orbit - surgery
Osteotomy
Otorhinolaryngologic Surgical Procedures - methods
Skull Base Neoplasms - surgery
Zygoma - surgery
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Summary:In the case of deep invasion of an infratemporal fossa (ITF) tumor, surgeons find it difficult to gain sufficient visualization and working space by conventional surgical approaches. To overcome these limitations, we have developed a novel surgical technique, maxillo-orbito-zygomatic (MOZ) approach, by combining partial lateral maxillectomy with the conventional orbito-zygomatic approach. A 63-year-old male presented with the fifth recurrent adenoid-cystic carcinoma in the right deep ITF. Using a Weber–Ferguson-type incision and partial dismasking, we elevated the skin and scalp flap, while preserving the facial nerve and orbicularis oculi muscle intact in the flap. Then, we performed MOZ osteotomy using three cut lines, the zygomatic arch, the frontozygomatic suture, and from the inferior orbital fissure to the anterolateral wall of the maxilla. Following this, we temporarily elevated the bone flap by partially opening the lateral maxillary sinus. We obtained an excellent surgical view of the ITF, middle skull base, and pterygopalatine fossa with this technique, which facilitated the safe removal of the tumor. The postoperative course remained almost uneventful, and we obtained favorable cosmetic results. Our novel MOZ approach could be a robust approach to remove deep ITF tumors.
ISSN:0385-8146
1879-1476
DOI:10.1016/j.anl.2018.12.010