Adenoid cystic carcinoma of the infraspheno-temporal fossa. Latero-facial resection combined with multiple osteotomies.

Two cases of Adenoid Cystic Carcinoma (ACC) of the infrasphenotemporal fossa with invasion of the floor of the middle fossa are presented. Preoperative studies included CT-scan and cervical and cerebral angiography. The exposure and operative management comprised a latero-facial approach combined with multiple exposure osteotomies of the ascending mandibular ramus, orbitozygomatic region and a frontosphenotemporal craniotomy. This approach provides wide exposure of the posterolateral orbit, sphenoid wing and infratemporal and pterygomaxillary fossa. One of our patients died from massive recurrence in proximity to the cavernous sinus and the other is free of disease after 30 months.