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

• 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
• ISSN: 0385-8146; 1879-1476
• DOI: 10.1016/j.anl.2018.12.010

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.