Mohiyuddin S M Azeem, Harsha Pooja, Maruvala Shreeharsha, Sumanth K R, Suresh T N, Manjunath G N, Sagayaraj A, Mohammadi Kouser, Babu A Prashanth, Deo R P
Department of ENT and Head and Neck Surgery, Sri Devaraj Urs Medical College, Tamaka, Kolar, 563101, India.
Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, 563101, India.
Eur Arch Otorhinolaryngol. 2018 Nov;275(11):2843-2850. doi: 10.1007/s00405-018-5124-z. Epub 2018 Sep 17.
Locally advanced oral cancers extending to infratemporal fossa (ITF) are a challenge to head and neck surgeons. These tumors are classified as T whenever the masticator space (MS), pterygoid muscles (PM), and pterygoid plates (PP) are involved according to AJCC classification. Until recently, these tumors were considered inoperable and treated only with palliative intent. However, a few studies in the last decade showed that many of these tumors could be resected with a reasonably favorable prognosis by compartment resection of ITF, particularly when the tumor was below sigmoid notch of mandible. A few studies attempted to downstage these tumors by neo-adjuvant chemotherapy before attempting resection. Oral Squamous cell carcinoma has a high prevalence in South India. Majority of these patients are females addicted to tobacco quid chewing and present with locally advanced disease. In this retrospective analysis, we evaluated the outcome of treatment of oral squamous cell carcinoma extending to ITF and staged T in 52 patients. All patients underwent Composite resection including compartment resection of ITF followed by adjuvant treatment. 20 patients had received neo-adjuvant chemotherapy. Pectoralis major myocutaneous flap was the mainstay of reconstruction. After mean follow-up of 2 years, 31 patients are alive and disease free. 14 patients had local recurrence in ITF and 2 patients had recurred in cervical nodes. 8 patients died due to disease and 6 are on palliative care. Neo-adjuvant chemotherapy did not benefit the outcome. Close margins of resection, extra nodal spread from lymph nodes and supra notch and involvement of posterior part of ITF were factors which predisposed to recurrence.
侵犯至颞下窝（ITF）的局部晚期口腔癌对头颈外科医生来说是一项挑战。根据美国癌症联合委员会（AJCC）的分类，只要咀嚼肌间隙（MS）、翼状肌（PM）和翼状板（PP）受累，这些肿瘤就被归类为T类。直到最近，这些肿瘤都被认为无法手术切除，仅进行姑息性治疗。然而，过去十年的一些研究表明，通过对ITF进行分区切除，许多此类肿瘤可以切除，预后相当良好，尤其是当肿瘤位于下颌骨乙状切迹以下时。一些研究试图在尝试切除之前通过新辅助化疗使这些肿瘤降期。口腔鳞状细胞癌在印度南部的患病率很高。这些患者大多数是有嚼烟草块习惯的女性，且表现为局部晚期疾病。在这项回顾性分析中，我们评估了52例侵犯至ITF且分期为T的口腔鳞状细胞癌患者的治疗结果。所有患者均接受了包括ITF分区切除在内的联合切除术，随后进行辅助治疗。20例患者接受了新辅助化疗。胸大肌肌皮瓣是重建的主要方式。平均随访2年后，31例患者存活且无疾病。14例患者在ITF出现局部复发，2例患者在颈部淋巴结复发。8例患者因疾病死亡，6例患者接受姑息治疗。新辅助化疗对治疗结果并无益处。切除切缘接近、淋巴结的结外扩散、切迹上方以及ITF后部受累是易于复发的因素。
