Hongo Takahiro, Fukushima Junichi, Uchida Yoshinori, Rikimaru Fumihide, Toh Satoshi, Higaki Yuichiro, Masuda Muneyuki
Department of Head and Neck Surgery.
Department of Plastic Surgery, National Kyushu Cancer Center, 3-1-1, Notame, Minamiku, Fukuoka 811-1395, Japan.
Auris Nasus Larynx. 2019 Dec;46(6):921-926. doi: 10.1016/j.anl.2018.12.010. Epub 2019 Jan 6.
In the case of deep invasion of an infratemporal fossa (ITF) tumor, surgeons find it difficult to gain sufficient visualization and working space by conventional surgical approaches. To overcome these limitations, we have developed a novel surgical technique, maxillo-orbito-zygomatic (MOZ) approach, by combining partial lateral maxillectomy with the conventional orbito-zygomatic approach.
A 63-year-old male presented with the fifth recurrent adenoid-cystic carcinoma in the right deep ITF. Using a Weber-Ferguson-type incision and partial dismasking, we elevated the skin and scalp flap, while preserving the facial nerve and orbicularis oculi muscle intact in the flap. Then, we performed MOZ osteotomy using three cut lines, the zygomatic arch, the frontozygomatic suture, and from the inferior orbital fissure to the anterolateral wall of the maxilla. Following this, we temporarily elevated the bone flap by partially opening the lateral maxillary sinus. We obtained an excellent surgical view of the ITF, middle skull base, and pterygopalatine fossa with this technique, which facilitated the safe removal of the tumor.
The postoperative course remained almost uneventful, and we obtained favorable cosmetic results.
Our novel MOZ approach could be a robust approach to remove deep ITF tumors.
对于颞下窝（ITF）肿瘤的深度侵袭情况，外科医生发现通过传统手术方法难以获得足够的视野和操作空间。为克服这些局限性，我们通过将部分上颌骨外侧切除术与传统眶颧入路相结合，开发了一种新型手术技术——上颌-眶-颧骨（MOZ）入路。
一名63岁男性患者，右侧颞下窝深部出现复发性腺样囊性癌。采用Weber-Ferguson型切口和部分揭面法，在皮瓣中保留面神经和眼轮匝肌完整的情况下，掀起皮肤和头皮瓣。然后，我们使用三条切割线进行MOZ截骨术，即颧弓、额颧缝以及从眶下裂至上颌骨前外侧壁。之后，通过部分打开上颌窦外侧壁暂时掀起骨瓣。通过该技术，我们获得了颞下窝、中颅底和翼腭窝的极佳手术视野，这有助于安全切除肿瘤。
术后病程几乎平稳，并且获得了良好的美容效果。
我们的新型MOZ入路可能是一种切除颞下窝深部肿瘤的有效方法。
