Trans-temporal bone posterolateral approach to recurrent malignant tumor in the infratemporal fossa

Honda Keigo, Asato Ryo, Kanda Tomoko, Watanabe Yoshiki, Tsujimura Takashi

doi:10.5981/jjhnc.39.305

The infratemporal fossa (ITF) is well known to be a difficult region to access surgically. Especially in salvage resection of recurrent malignant tumors in the ITF, modifications of classic surgical approaches are often needed. We report 2 cases of recurrent malignant tumors located around the Eustachian tube, which were resected successfully via a trans-temporal bone approach. In both of the cases, the tumor was of low grade malignant potential and recurred after a skull base resection for an ITF lesion. The recurrent lesion was resected in an en-bloc fashion with negative margins using a trans-temporal bone approach, which is a modification of subtotal temporal bone resection. In the procedure, dissection of the scar tissue surrounding the internal carotid artery was the most difficult step. Free rectus abdominis myocutaneous flap was effective to fill the dead space after resection. The advantages of this approach are that it is a modification of the established technique of subtotal temporal bone resection, thus reproducible, and that en-bloc resection of the tumor around the Eustachian tube is possible. The disadvantage is that the facial and the vestibular nerves are sacrificed in most cases. As a posterolateral approach to the ITF, this method is useful for resecting recurrent ITF tumors involving the Eustachian tube.

Trans-temporal bone posterolateral approach to recurrent malignant tumor in the infratemporal fossa

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