Surgery for Malignant Maxillary Tumors Involving the Middle Cranial Fossa

ABSTRACT

The purpose of this study was to evaluate the disease-free survival (DFS) of patients with maxillary malignant tumors invading the middle cranial fossa (MCF) who underwent a lateral or anterolateral skull base resection. This study was a retrospective analysis in a tertiary referral center and included 62 patients with maxillary malignant tumors invading the MCF (stage T4b) treated with surgery with or without postoperative radiotherapy. All patients had sharp pain and involvement of at least one branch of the trigeminal nerve. Twenty-eight patients had not been treated previously, and 34 had previously been treated elsewhere. The MCF dura was infiltrated and resected in 36 cases, and in nine of these, there was an intradural extension of the tumor, with temporal lobe and/or cavernous sinus invasion. Thirty-six patients underwent reconstruction with a temporalis muscle pedicled flap, and 26 patients with a free flap. There was a 22% overall rate of postoperative complications, but no intraoperative deaths. The median follow-up time was 49 months (range 2 to 186). Overall DFS was 33.9% and was higher for untreated patients (46.4% versus 23.5%) and for patients in whom clean margins were achieved (51.4% versus 12.5%). The survival time for patients who died of disease was 9 months for squamous cell carcinoma and 38 months for adenoid-cystic carcinoma. All patients experienced anesthesia in the territory of the resected trigeminal branches, but their pain vanished, and their quality of life improved. Lateral skull base surgery may achieve satisfactory oncologic results for patients with low-grade tumors, with improved quality of life for almost all patients.

KEYWORDS

Maxillary malignant tumors - middle cranial fossa - skull base surgery - quality of life

REFERENCES

• 1 Dulguerov P, Jacobsen M S, Allal A S, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress?.  Cancer. 2001;  92 3012-3029
• 2 Katz T S, Mendenhall W M, Morris C G, Amdur R J, Hinerman R W, Villaret D B. Malignant tumors of the nasal cavity and paranasal sinuses.  Head Neck. 2002;  24 821-829
• 3 Stell P M. History of surgery of the upper jaw. In: Harrison D, Lund VJ Tumours of the Upper Jaw. Edinburgh; Churchill Livingstone 1993: 1-15
• 4 Öhngren L G. Malignant tumors of the maxillary-ethmoidal region.  Acta Otolaryngologica (Stockolm). 1933;  Suppl 19 1-476
• 5 Dingman D L, Conley J. Lateral approach to the pterygomaxillary region.  Ann Otol Rhinol Laryngol. 1970;  79 967-969
• 6 Ketcham A S, Wilkins R H, Vanburen J M, Smith R R. A combined intracranial facial approach to the paranasal sinuses.  Am J Surg. 1963;  106 698-703
• 7 Patel S G, Singh B, Polluri A et al.. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study.  Cancer. 2003;  98 1179-1187
• 8 Ganly I, Patel S G, Singh B et al.. Craniofacial resection for malignant paranasal sinus tumors: Report of an International Collaborative Study.  Head Neck. 2005;  27 575-584
• 9 Fisch U. Infratemporal fossa approach to tumours of the temporal bone and base of the skull.  J Laryngol Otol. 1978;  92 949-967
• 10 Krespi Y P, Sisson G A. Transmandibular exposure of the skull base.  Am J Surg. 1984;  148 534-538
• 11 Close L G, Mickey B E, Samson D S, Anderson R G, Schaefer S D. Resection of upper aerodigestive tract tumors involving the middle cranial fossa.  Laryngoscope. 1985;  95 908-914
• 12 Schramm V L. Infratemporal fossa surgery. In: Sekhar LN, Schramm VL Tumors of the Cranial Base. Mount Kisko, NY; Futura Publishing 1987: 235-251
• 13 Janecka I P, Sen C, Sekhar L N et al.. Cranial base surgery: results in 183 patients.  Otolaryngol Head Neck Surg. 1994;  110 539-546
• 14 Pitman K T, Prokopakis E P, Aydogan B et al.. The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinonasal tract.  Head Neck. 1999;  21 402-407
• 15 Carrillo J F, Rivas Leon B, Celis M A, Ponce-de-Leon S, Ochoa-Carrillo F J. Anterolateral and lateral skull-base approaches for treatment of neoplastic diseases.  Am J Otolaryngol. 2004;  25 58-67
• 16 Llorente J L, Nazar G, Cabanillas R, Fernández de León R, Suárez C. Subtemporal-preauricular approach in the management of infratemporal and nasopharyngeal tumours.  J Otolaryngol. 2006;  35 173-179
• 17 Bigelow D C, Smith P G, Leonetti J P, Backer R L, Grubb R L, Kotapka M J. Treatment of malignant neoplasms of the lateral cranial base with the combined frontotemporal-anterolateral approach: five-year follow-up.  Otolaryngol Head Neck Surg. 1999;  120 17-24
• 18 Irish J C, Gullane P J, Gentili F et al.. Tumors of the skull base: outcome and survival analysis of 77 cases.  Head Neck. 1994;  16 3-10
• 19 Fordice J, Kershaw C, El-Naggar A, Goepfert H. Adenoid cystic carcinoma of the head and neck: predictors of morbidity and mortality.  Arch Otolaryngol Head Neck Surg. 1999;  125 149-152
• 20 Douglas J G, Laramore G E, Austin-Seymour M et al.. Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands.  Int J Radiat Oncol Biol Phys. 1996;  36 87-93