Smith P G, Sharkey D E
Otolaryngol Head Neck Surg. 1986 Mar;94(3):291-301. doi: 10.1177/019459988609400306.
Between 1982 and 1984, a modified infratemporal fossa approach was used to resect cancers with extensive primary or secondary involvement of the infratemporal fossa and parapharynx in 10 patients. Nine patients exhibited persistent or recurrent disease of the upper aerodigestive tract and posterior cranial fossa following planned, curative-intent therapy; the remaining patient had a carcinoma ex-pleomorphic adenoma of the deep lobe of the parotid gland with a significant infratemporal fossa extension. Considered to have "unresectable" tumors, by traditional methods, 7 of the 10 patients underwent an en-bloc resection of their lesions with tumor-free margins. Tumor was present at the margins of the specimens in the other 3 patients. Two of the 10 patients died early in the postoperative period of medical complications. Another died 5 months postoperatively of a tumor-induced internal carotid artery rupture at the level of the foramen lacerum. A fourth patient died of his disease 6 months following his resection. One patient is alive, but has metastatic meningioma 2 years after surgery. The 5 remaining patients are without evidence of disease, with a mean follow up of 2 years. Indications for and refinements of the operative technique, particularly those related to the repair of such extensive ablative defects, are outlined on the basis of this early experience.
1982年至1984年间，采用改良颞下窝入路对10例颞下窝和咽旁间隙原发性或继发性广泛受累的癌症患者进行了肿瘤切除。9例患者在接受了计划性的根治性治疗后，出现了上呼吸道消化道和后颅窝的持续性或复发性疾病；其余1例患者患有腮腺深叶的癌性多形性腺瘤，肿瘤明显向颞下窝扩展。按照传统方法，这10例患者中有7例被认为患有“无法切除”的肿瘤，但他们均接受了整块切除，切缘无肿瘤残留。另外3例患者的标本切缘有肿瘤残留。10例患者中有2例在术后早期死于并发症。另1例患者在术后5个月因肿瘤导致的颈内动脉在破裂孔水平破裂而死亡。第4例患者在切除术后6个月死于疾病。1例患者存活，但术后2年发生了转移性脑膜瘤。其余5例患者无疾病证据，平均随访2年。基于这一早期经验，本文概述了该手术技术的适应证及改进方法，尤其是与修复此类广泛切除后缺损相关的技术改进。
