Anterolateral corridor approach to the infratemporal fossa and central skull base in maxillectomy: rationale and technical aspects
Introduction
Local recurrence remains the most common manifestation of relapse after treatment for midfacial cancer.1, 2, 3, 4, 5, 6 In most patients it follows a predictable pattern, which can be explained by the relative inaccessibility of posterior and superior disease, and the proximity of vital structures,2, 6 and it is reflected in the T-staging for carcinoma of the maxillary sinus and ethmoid sinus.7
To maximise the likelihood of cure, operation is usually indicated for cancer of the midface,2, 6 and resection to uninvolved margins remains essential. The traditional technique for maxillectomy relies on posterior separation, which gives a poor view and inadequate vascular control, and for advanced and posteriorly-extending cancers of the maxilla it makes complete excision difficult.
We describe the technical aspects of an expanded field resection for cancer that involves the posterior maxilla, and report our experience.
Section snippets
Anatomical position of the maxillary artery in relation to the lateral pterygoid muscle
We examined 100 contrast-enhanced computed tomograms (CT) (slice width 0.9 mm, 200-300 mAs) from a consecutive series of patients with cancer of the head and neck, and noted the course of the maxillary artery with particular reference to the lateral pterygoid muscle. To measure the variance between observations, scans were read twice and the 2 readings were separated by 2 weeks.
Cadaveric investigation
We dissected 3 formalin-fixed cadaver heads (6 sides) using the anterolateral corridor approach. Maxillectomy was done
Evaluation of the anatomical relation of the maxillary artery to the lateral pterygoid muscle (on contrast CT)
We recorded 3 types of relation of the maxillary artery to the lateral pterygoid muscle: posteromedial, anterolateral, and posteromedial to anterolateral. In 20% of the patients there was asymmetry in the course of the maxillary artery. A total of 46 patients were female and 54 were male but its course did not differ significantly between sexes.
In 53 cases, the artery passed for most of its course on the right of the posteromedial aspect of the lateral pterygoid muscle, and it passed
Discussion
Local recurrence remains the most common sign that treatment for midfacial cancer has failed, irrespective of the type of disease and the treatment given.1, 2, 3, 4, 5, 6 We have previously reported that it often occurs in posterior and superior sites,4 specifically, the infratemporal fossa and orbital apex and, through the foramina at the base of the skull, in the cavernous sinus, Meckel's cave, and petrous apex. It has also been described by others,9, 10 and suggests an anatomical
Conflict of interest
We have no conflicts of interest.
Ethics statement/confirmation of patient's permission
This project was approved by the Clinical Network. Written consent for inclusion of images has been granted by the patient concerned and is held in the medical illustration dataset.
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Development of a cadaveric head and neck cancer model and three-dimensional analysis of margins in surgical navigation-aided ablations
2022, European Journal of Surgical OncologyCitation Excerpt :While this approach can provide acceptable results in terms of completeness of resection in many HN sites, there is an unmet need to increase the rate of negative margins, particularly in cancers invading the craniofacial area [2–6]. Owing to the complex 3D extent of many HN malignancies, several technical and technological refinements have been advocated to improve the quality of oncologic ablations [1,5,7–11]. Margin involvement represents one of the main negative prognosticators in most HN cancers [12].
Variation in UK Deanery publication rates in the British Journal of Oral and Maxillofacial Surgery: where are the current 'hot spots'?
2021, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Publications for the Defence Postgraduate Medical Deanery were grouped in the location of their associated training unit. Eighty-four issues of BJOMS published between January 2011 and December 2019, spanning volumes 49-59, were included9–384. These represented 378 full-length articles published by UK-based units.
Endoscopic-assisted maxillectomy: Operative technique and control of surgical margins
2019, Oral OncologyCitation Excerpt :Other series describing a technique intended to improve the posterior margin control showed comparable rate of recurrence (21.4% [5], 29.0% [6], 32.3%) [7] with similar or slightly longer follow-up duration (mean: 20.1, 43.4, 38.4 months, respectively) with respect to the present study. In the series described by McMahon et al., the rate of local recurrence in patients undergoing maxillectomy via anterolateral corridor approach was as low as 11.4%, with a median follow-up of 27–36 months [40]. Despite the low rate of medial and posterior positive margins, local recurrence at these sites was observed in roughly half (8 patients, 53.3%) of patients with local recurrence in our series (Table 2).