Solitary fibrous tumours of the infratemporal fossa. Two case reports

Tumors Involving the Infratemporal Fossa: A Systematic Review of Clinical Characteristics and Treatment Outcomes

BACKGROUND

Infratemporal fossa (ITF) tumors represent various pathologies and are seldom described in the literature, reflecting their rarity. Here we review the literature on tumors invading ITF and describe patient characteristics, treatment strategies, and clinical outcomes.

METHODS

Relevant articles were retrieved from PubMed, Scopus, and Cochrane. A systematic review and meta-analysis were conducted on the clinical presentation, treatment protocols, and clinical outcomes.

RESULT

A total of 27 articles containing 106 patients with ITF tumors (median tumor size: 24.3 cm³ [interquartile range, 15.2-42 cm³]) were included (median age: 46 years [interquartile range, 32-55 years]; 59.4% were males]). Of the confirmed tumor pathology data, schwannomas (n = 24; 26.1%) and meningiomas (n = 13; 14.1%) were the most common tumors. Facial hypoesthesia (n = 22; 18.5%), auricular/preauricular pain (n = 20; 16.8%), and headaches (n = 11; 9.2%) were the most common presenting symptoms. Of patients who had surgical resection (n = 97; 95.1%), 70 (73.7%) had transcranial surgery (TCS) and 25 (26.3%) had endoscopic endonasal surgery (EES). Among available details on the extent of resection (n = 84), gross-total resection (GTR) was achieved in 62 (73.8%), and 5 (6.0%) had biopsy only. Thirty-five (33.0%) patients had postoperative complications. Among cases with available data on reconstruction techniques (n = 8), four (50%) had adipofascial antero-lateral thigh flap, three (37.5%) had latissimus dorsi free flap, and one (12.5%) had antero-lateral thigh flap. Fourteen (13.2%) patients had adjuvant chemotherapy, and sixteen (15.1%) had adjuvant radiotherapy. During a median follow-up time of 28 months (IQR, 12.25-45.75 months), 15 (14.2%) patients had recurrences, and 18 (17.0%) patients died. The median overall survival (OS) time was 36 months (95% confidence interval: 29-41 months), and the 5-year progression-free survival (PFS) rate was 61%.

CONCLUSION

Various tumor types with different biological characteristics invade the ITF. The present study describes patient demographics, clinical presentation, management, and outcomes. Depending on the tumor type and patient condition, patient-tailored management is recommended to optimize treatment outcomes.

Transoral surgical approach to solitary fibrous tumors in buccal space with infratemporal tumor extension: A case report

A solitary fibrous tumour (SFT) is a rare spindle-cell neoplasm of mesenchymal origin usually located in the pleura. It has been recently described as occurring in various head and neck sites, including the oral cavity. The purpose of this article is to report a case of SFT originating in the buccal space and extending into the infratemporal space treated by means of transoral approach surgery. A 25-year-old female patient reported to the Department of Oral and Maxillofacial Surgery, Universitas Airlangga Hospital, chiefly complaining of a painless lump in the left cheek which had been present for nine months. The diagnosis was arrived at on the basis of a combination of clinical investigation, imaging studies and histopathological examination (biopsy). The surgical approach involved transoral incision through the buccal mucosa. An SFT of buccal space may extend to nearby structures producing the anatomical challenge of removal through a transoral approach. Excisional biopsy involving a transoral approach is, nevertheless, considered appropriate because it produces an attractive aesthetic appearance, reduces morbidity from nerve/ vascular/ gland injury and promotes more effective healing. Key words:Solitary fibrous tumor, buccal space, infratemporal space, transoral approach.

Use of submandibular gland flap for repairing defects after tumor resection in the infratemporal region

OBJECTIVE

To investigate the application of submandibular gland flap with facial artery and vein pedicle, for repairing defects following tumor resection in the infratemporal region.

PATIENTS AND METHODS

Fifteen patients, including eight males and seven females ranging in age from 21 to 73 years, underwent surgical resection of tumors in the infratemporal region. Tumors were exposed using the submandibular incision approach and completely resected after pulling and rotating the mandible laterally. Mandibular osteotomy was performed for larger tumors or those that were not completely exposed. After tumor resection, the submandibular gland flap was used to fill up the residual defect following tumor resection.

RESULTS

The incisions healed well without exudation or infection (primary healing) postoperatively in all the patients. Long-term follow-up showed no tumor recurrence in all cases. Seven of the patients who underwent mandibular ramus osteotomy had numbness of the lower lip due to inferior alveolar nerve injury. No other complications were observed postoperatively.

CONCLUSION

The submandibular gland flap with facial artery and vein pedicle is a reliable, effective, and easy approach for repairing the defects caused by tumor resection in the infratemporal region, and has great potential for application in the clinical setting.

[Solitary fibrous tumor of the meninges: report of three cases]

The authors expose the clinical, radiological and histological presentation of three cases of solitary fibrous tumors of the meninges, initially thought to be meningiomas. Actually, these three cases show typical anatomoclinical features. The authors also mention the differential diagnosis, and recall the essential contribution of immunohistochemistry.

Haemangiopericytoma of the mandible

Haemangiopericytomas (HPCs) found in bony structures are rare sarcomas of vascular origin. Here, we report the case of a 41-year-old female with a HPC originating in the right ramus of the mandible. After tumour staging and biopsy for histological reference the tumour was surgically removed. The surgical technique is described and therapy options of these rare cases are discussed and compared with these cases already documented. To the best of our knowledge, this is the 6th case of mandibular HPC reported in the literature.