[Malignant maxillary tumors involving the pterygo-maxillary and infratemporal fossae: a series of 65 patients and a comparison of the 1997 and 1977 UICC-AJCC staging systems].

The prognosis for maxillary malignancies with posterior extension to the pterygo-maxillary and infratemporal fossae is worse than for those with anterior-inferior extrinsication. Maxillectomy using only an anterior approach does not enable enblock, radical resection of such tumors. Many different approaches to the infratemporal fossae have been described in the literature. The authors use a double infratemporal and transfacial approach. Between 1990 and 1998 this approach was used on 65 patients with malignant maxillary tumors. There was one post-operative death due to myocardial infarction. There were only 9 cases of temporal infection, and all were resolved. There were no cases of necrosis of either the temporal muscle or the revascularized flaps. The cases included the following tumors: spinocellular and anaplastic carcinoma (21 cases); adenoid-cystic carcinoma (16); adenocarcinoma (4); sarcoma (18); other malignant tumors (6). There were 29 primary tumors while the remaining 36 were recurrences from prior treatment. Using the UICC-AICC 1987-92 staging system there were 22 cases of T3 and 43 T4. Using the 1997 system there were 35 T3s and 30 T4s. Resection was radical in 54 cases while in the remaining 11 there were micro or macroscopic limitations at the rhinopharyngeal level and/or at the orbit apex. The NED survival percentages were: T3 59.2%; T4 28% (using the 1987-92 system) while they were T3 45.7% and T4 26.7% (using the 1997 system). In the 41 patients with carcinoma (spinocellular, anaplastic, adeno and adenoid-cystic) the NED survival percentages were: T3 54.5%; T4 23.4% (using the 1987-92 system) while they were T3 45% and T4 19% (using the 1997 system). The NED survival percentage was 41.4% for primary tumors and 36.1% for recurrences. These results lead one to conclude that this surgical technique permits good results with T3-T4 maxillary malignancies. The prognosis for recurrences is worse than for primary tumors and the prognosis for sarcoma is better than for carcinoma. The UICC-AICC staging systems are valid for prognostic purposes. The current analyses indicate that the 1987-92 system is slightly more suitable than the 1997 system. In fact, there were 13 patients which the 1987-92 system had classified as T4 and which the 1997 system had reclassified as T3. In all these cases the prognosis was more similar to that of T4 than T3.