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Yu S, Gao Z, Sun H, Tian X, Zhao Y, Feng G. Quality of Life in Patients With Benign Lateral Skull Base Neoplasms Following Infratemporal Fossa Approaches. EAR, NOSE & THROAT JOURNAL 2023:1455613231186049. [PMID: 37458127 DOI: 10.1177/01455613231186049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objectives: Infratemporal fossa approaches (IFAs) allow the total resection of certain lateral skull base neoplasms. To date, no studies have explored the change of patient-reported quality of life (QoL) after total resection of benign lateral skull base neoplasms through IFA. The present study aimed to give a comprehensive understanding of QoL among patients after IFA through general and disease-specific QoL questionnaires. Methods: Forty-seven patients with benign lateral skull base neoplasms were enrolled. The Short Form 36 (SF-36), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the University of Washington Head and Neck Quality of Life (UW-QOL) were chosen as tools to assess QoL before and after surgeries through IFA. Results: Patients had significantly lower scores in appearance, chewing, and speech after surgeries through IFA. However, change in health from SF-36 and physical health from WHOQOL-BREF scored higher after surgery. In multivariate linear regression analysis, age, gender, mood, speech, appearance, swallowing, and chewing contributed independently to general QoL. Conclusion: Patients were shown to benefit with regard to overall QoL after gross tumor resection from IFA, despite the impact of appearance, speech, and chewing. Function preservation and restoration are critical since their correlation with postoperative QoL.
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Affiliation(s)
- Shuting Yu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiqiang Gao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Huiying Sun
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Tian
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Zhao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guodong Feng
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Functional Outcomes Following Temporomandibular Joint Dissection Performed During Surgery for Skull Base Tumors. Otol Neurotol 2021; 41:e363-e368. [PMID: 31821264 DOI: 10.1097/mao.0000000000002519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During skull base tumor surgery, temporomandibular joint (TMJ) dissection is commonly performed. The impact of this procedure on patients' postoperative diet and TMJ function is a matter of concern to surgeons. METHODS We reviewed the Craniomandibular Index (CMI) for 32 patients (15 men and 17 women) who underwent TMJ dissection during surgery for skull base tumors between August 2015 and May 2018. RESULTS Fifteen patients underwent removal of the mandibular condyle, and 17 had the condyle preserved. Twenty-one patients mainly underwent infratemporal fossa approach, and 11 underwent extended temporal bone resection. No significant difference between pre- and postoperative diet was observed in any group. Significant differences in CMI index were seen in all groups. The highest score was 0.115 of Dysfunction Index, observed postoperatively in the group that underwent condyle removal. CONCLUSIONS For skull base tumor surgery, TMJ dissection has no significant impact on postoperative diet. Patients who underwent removal of the mandibular condyle have significantly worse postoperative TMJ function.
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Gerges MM, Godil SS, Younus I, Rezk M, Schwartz TH. Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study. J Neurosurg 2020; 133:1948-1959. [PMID: 31675695 DOI: 10.3171/2019.7.jns191743] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The infratemporal fossa (ITF) and parapharyngeal space are anatomical regions that can be challenging to access without the use of complex, cosmetically disfiguring approaches. With advances in endoscopic techniques, a new group of surgical approaches to access the intracranial space through the orbit has been recently referred to as transorbital neuroendoscopic surgery (TONES). The objective of this study was to establish a transorbital endoscopic approach utilizing the inferior orbital fissure (IOF) to gain access to the ITF and parapharyngeal space and provide a detailed endoscopic anatomical description of this approach. METHODS Four cadaveric heads (8 sides) were dissected using a TONES approach through the IOF to reach the ITF and parapharyngeal space, providing stepwise dissection with detailed anatomical findings and a description of each step. RESULTS An inferior eyelid approach was made with subperiosteal periorbital dissection to the IOF. The zygomatic and greater wing of the sphenoid were drilled, forming the boundaries of the IOF. The upper head of the lateral pterygoid muscle in the ITF and parapharyngeal space was removed, and 7 distinct planes were described, each with its own anatomical contents. The second part of the maxillary artery was mainly found in plane 1 between the temporalis laterally and the lateral pterygoid muscle in plane 2. The branches of the mandibular nerve (V3) and middle meningeal artery (MMA) were identified in plane 3. Plane 4 was formed by the fascia of the medial pterygoid muscle (MTM) and the tensor veli palatini muscle. The prestyloid segment, found in plane 5, was composed mainly of fat and lymph nodes. The parapharyngeal carotid artery in the poststyloid segment, found in plane 7, was identified after laterally dissecting the styloid diaphragm, found in plane 6. V3 and the origin of the levator and tensor veli palatini muscles serve as landmarks for identification of the parapharyngeal carotid artery. CONCLUSIONS The transorbital endoscopic approach provides excellent access to the ITF and parapharyngeal space compared to previously described complex and morbid transfacial or transcranial approaches. Using the IOF is an important and useful landmark that permits a wide exposure.
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Affiliation(s)
- Mina M Gerges
- 1Department of Neurosurgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
- Departments of2Neurosurgery and
| | - Saniya S Godil
- 1Department of Neurosurgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
- 3Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Iyan Younus
- 4Weill Cornell Medical College, New York, New York
| | - Michael Rezk
- 5Otolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Theodore H Schwartz
- 1Department of Neurosurgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Carsuzaa F, Gorphe P, Vergez S, Malard O, Fakhry N, Righini C, Philouze P, Lasne-Cardon A, Gallet P, Tonnerre D, Bozec A, de Mones E, Baujat B, Laccourreye L, Babin E, Dufour X, Thariat J. Consensus on resectability in N3 head and neck squamous cell carcinomas: GETTEC recommendations. Oral Oncol 2020; 106:104733. [PMID: 32335323 DOI: 10.1016/j.oraloncology.2020.104733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Among patients with T0-2 N3 head and neck squamous cell carcinomas (HNSCC), those undergoing upfront neck dissection have better oncological outcomes. However, there is no consensual definition of disease resectability of N3 nodes, leading to major treatment attrition and interpretation biases between studies. We established a Delphi method-based consensus to define resectability and impact on decision-making for upfront neck dissection in N3 patients. METHODS The Delphi method was designed as recommended by the French Haute Autorite de Sante among head and neck surgeons from university hospitals and cancer centers, using a 24-item questionnaire. Strong and relative agreements were subsequently established, and recommendations were written. The resulting recommendations were assessed by 30 independent surgeons. RESULTS N3 nodes with intraparenchymal brain invasion, foramen invasion, skull base erosion, nodes requiring bilateral XIIth cranial nerve sacrifice, retropharyngeal N3 node or a node above the plan of soft palate are major contraindications to neck dissection. When neck dissection requires unilateral sacrifice of the IXth or Xth or XIIth cranial nerves or cervical nerve roots, upfront neck dissection may be performed, based on a case-by-case assessment of other patient and tumor estimates. CONCLUSION Consensual contraindications to neck dissection in patients with T0-2 N3 HNSCC were defined among French head and neck surgeons as concerns skull base invasion, retropharyngeal nodes and bilateral XIIth cranial nerve sacrifice. This consensus should allow more reliable comparisons between surgical and non-surgical strategies in N3 patients.
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Affiliation(s)
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Sébastien Vergez
- Institut Universitaire du Cancer de Toulouse Oncopole, University Hospital of Toulouse, France
| | - Olivier Malard
- Head and Neck Surgery, University Hospital of Nantes, France
| | - Nicolas Fakhry
- Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France
| | | | - Pierre Philouze
- Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon (Hospital Group of Lyon), France
| | | | - Patrice Gallet
- Head and Neck Surgery, University Hospital of Nancy, France
| | - Denis Tonnerre
- Head and Neck Surgery, University Hospital of Poitiers, France
| | - Alexandre Bozec
- Head and Neck Surgery, Institut Universitaire de la Face et du Cou, Nice, France
| | - Erwan de Mones
- Head and Neck Surgery, University Hospital of Bordeaux, France
| | | | | | - Emmanuel Babin
- Head and Neck Surgery, Centre François Baclesse, Caen, France
| | - Xavier Dufour
- Head and Neck Surgery, University Hospital of Poitiers, France
| | - Juliette Thariat
- Radiation Oncology, Centre François Baclesse/ARCHADE, Caen, France.
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Middle infratemporal fossa less invasive approach for radical resection of parapharyngeal tumors: surgical microanatomy and clinical application. Neurosurg Rev 2015; 39:87-96; discussion 96-7. [PMID: 26160680 DOI: 10.1007/s10143-015-0655-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/22/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
Surgery of the infratemporal fossa (ITF) and parapharyngeal area presents a formidable challenge to the surgeon due to its anatomical complexity and limited access. Conventional surgical approaches to these regions were often too invasive and necessitate sacrifice of normal function and anatomy. To describe a less invasive transcranial extradural approach to ITF parapharyngeal lesions and to determine its advantages, 17 patients with ITF parapharyngeal neoplasms who underwent tumor resection via this approach were enrolled in the study. All lesions located in the ITF precarotid parapharyngeal space were resected through a small operative corridor between the trigeminal nerve third branch (V3) and the temporomandibular joint (TMJ). Surgical outcomes and postoperative complications were evaluated. Pathological diagnosis included schwannoma in eight cases, paraganglioma in two cases, gangliocytoma in two cases, carcinosarcoma in one case, giant cell tumor in one case, pleomorphic adenoma in one case, chondroblastoma in one case, and juvenile angiofibroma in one case. Gross total resection was achieved in 12 cases, near-total and subtotal resection were in 3 and 2 cases, respectively. The most common postoperative complication was dysphagia. Surgical exposure can be customized from minimal (drilling of retrotrigeminal area) to maximal (full skeletonization of V3, removal of all structures lying lateral to the petrous segment of internal carotid artery) according to tumor size and location. Since the space between the V3 and TMJ is the main corridor of this approach, the key maneuver is the anterior translocation of V3 to obtain an acceptable surgical field.
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Youssef A, Carrau RL, Tantawy A, Ibraheim A, Solares AC, Otto BA, Prevedello DM, Filho LD. Endoscopic versus Open Approach to the Infratemporal Fossa: A Cadaver Study. J Neurol Surg B Skull Base 2015; 76:358-64. [PMID: 26401477 DOI: 10.1055/s-0035-1549003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/26/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction Various lateral and anterior approaches to access the infratemporal fossa (ITF) have been described. We provide our observations regarding the endoscopic transpterygoid and preauricular subtemporal approaches, listing their respective advantages and limitations through cadaveric dissection. Methods A cadaver study was performed on five adult specimens. An endoscopic transpterygoid approach to the ITF was completed bilaterally in three specimens, and an open preauricular ITF approach was performed bilaterally in two specimens. Results After completing the cadaveric dissections, we studied differences between the endoscopic transpterygoid approach and open preauricular subtemporal approaches in regard to exposure and ease of dissection of different structures in the ITF. Conclusions In comparison with a lateral approach, the endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure of median structures such as the nasopharynx, eustachian tube, sella, and clivus. We concluded that the endoscopic transpterygoid approach can be utilized to resect benign lesions and some select group of malignancies involving the infratemporal and middle cranial fossae. Open approaches continue to play an important role, especially in the resection of extensive malignant tumors extending to these regions.
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Affiliation(s)
- Ahmed Youssef
- Department of Otolaryngology-Head and Neck Surgery, Alexandria University, El Azareeta, Alexandria, Egypt
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
| | - Ahmed Tantawy
- Department of Otolaryngology-Head and Neck Surgery, Alexandria University, El Azareeta, Alexandria, Egypt
| | - Ahmed Ibraheim
- Department of Otolaryngology, Alexandria Medical School, Ramel Station, Alexandria, Egypt
| | - Arturo C Solares
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents Medical Center, Augusta, Georgia, United States
| | - Bradley A Otto
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
| | - Daniel M Prevedello
- Department of Neurosurgery, The University of Ohio, Columbus, Ohio, United States
| | - Leo Ditzel Filho
- Department of Neurosurgery, The University of Ohio, Columbus, Ohio, United States
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Woodford R, Chaudhary N, Wolf A, Lownie S, Armstrong JE. A Modified Retromaxillary Approach to the Infratemporal Fossa: Three Case Studies. J Oral Maxillofac Surg 2015; 73:769-80. [DOI: 10.1016/j.joms.2014.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022]
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Timoshenko AP, Asanau A, Gavid M, Colin V, Martin C, Prades JM. Preauricular transmandibular and transzygomatic approach for tumors of the infratemporal fossa revisited. ORL J Otorhinolaryngol Relat Spec 2013; 75:250-5. [PMID: 23921824 DOI: 10.1159/000351554] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 04/17/2013] [Indexed: 11/19/2022]
Abstract
AIM To demonstrate the surgical technique and results in patients operated on with a preauricular transmandibular transzygomatic approach. METHODS This surgical technique was used in 21 patients with benign and malignant tumors of the infratemporal fossa (ITF), operated on between 1999 and 2011. RESULTS Twenty-one patients were enrolled in the study. There were 6 patients with benign tumors and 15 with malignant ones. No patients with benign lesions show any disease recurrence 5 years after surgery and present excellent functional and cosmetic results. Postoperatively, a reduction of pain was noted in all patients with malignant lesions. Four patients in this group, who are alive 5 years after surgery, do not demonstrate any disease progression. CONCLUSION The described approach provides an excellent exposure of the ITF and could be the procedure of choice in the management of ITF tumors.
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Affiliation(s)
- Andrei P Timoshenko
- Department of Otolaryngology, Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Centre, Saint-Etienne, France
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Prades JM, Timoshenko A, Merzougui N, Martin C. A cadaveric study of a combined trans-mandibular and trans-zygomatic approach to the infratemporal fossa. Surg Radiol Anat 2003; 25:180-7. [PMID: 12904903 DOI: 10.1007/s00276-003-0126-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2002] [Accepted: 02/10/2003] [Indexed: 10/26/2022]
Abstract
The infratemporal fossa (ITF) is a deep retromaxillary space corresponding to the inferior aspect of the middle cranial fossa. There are numerous surgical approaches, indicating the difficulty of access, accentuated by the communications with the neighboring regions. The aim of this anatomical study was the optimization and photographic demonstration of the pre-auricular infra-temporal trans-zygomatic approach combined with a trans-mandibular approach allowing access to the different regions of the ITF. Six human heads preserved in formalin were dissected under the operating microscope (magnification between x6 and x4). Intra-arterial injection of colored silicone had been done in advance. A plastinated hemi-head was conserved as a teaching and training specimen using the S10 silicone technique. After a pre-auricular temporo-cervical incision, skin flaps, the superficial temporalis fascia and the temporal fascia were elevated. The facial nerve and its branches were preserved and the temporal and zygomatic branches were protected by the superficial temporalis fascia. The division of the temporal muscle and osteotomy of the zygomatic arch opened the superior part of the ITF. Osteotomy of the mandibular ramus preserving the division of the mandibular nerve opened the inferior part of the ITF. This was thus perfectly exposed and access was not impeded by the trunk of the facial nerve and its branches. The place of this complex approach is discussed among the principal exocranial surgical approaches to the ITF.
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Affiliation(s)
- J-M Prades
- Laboratoire d'Anatomie, Faculté de Médecine Jacques Lisfranc and Service d'ORL et Chirurgie cervico-faciale, CHU Bellevue, Saint-Etienne, France.
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