Combined infratemporal fossa and transfacial approach to excising massive tumors.

Massive tumors of the infratemporal and pterygopalatine fossa are usually resected via the Fisch type C infratemporal fossa approach. This approach provides the surgeon with wide enough access to safely remove massive tumors, and it allows excellent control of the internal carotid artery without leaving facial scars. The disadvantages of this approach include a total loss of hearing on the affected side and the risk of damage to the facial nerve. The Fisch type D infratemporal preauricular approach provides a limited access to tumors, but it does preserve hearing. We studied the practice of combining the Fisch type D approach with a transfacial, transmaxillary approach. This allows the removal of massive tumors of the area without the necessity of resorting to the type C approach and the resultant loss of hearing and the possibility of facial paralysis. The flexibility of the type D infratemporal fossa approach allows the surgeon to combine it with transmaxillary, transmandibular, and periorbital approaches to remove tumors of all sizes from the infratemporal fossa, pterygopalatine fossa, parapharyngeal space, and orbit.