Pillai Vijay, Tiwari Manish, Kuriakose Moni
Department of Head and Neck Surgical Oncology, Narayana Health, Bangalore, India.
Department of Head and Neck Surgical Oncology, Karkinos Healthcare, Kolkata, India.
J Maxillofac Oral Surg. 2024 Aug;23(4):747-762. doi: 10.1007/s12663-024-02224-2. Epub 2024 Jul 6.
Management of advanced gingivo-buccal complex cancers involving the masticatory space (T4b) is often managed by compartment resection. The oncological safety of the procedure is now clearly established. Based on the origin and epicenter of the tumor there are two classes of compartmental resection. Those tumors arising from the tuberosity of the maxilla and/or upper gingival sulcus region; the resection involves the tumor, posterior maxilla, and the ipsilateral infratemporal fossa. These tumors can be resected by mandibulotomy approach, preserving the mandible. This constitutes class-1 infratemporal fossa resection. The class-2 infratemporal fossa resection is applied for those tumors arising from the retromolar trigone and/or lower gingivo-buccal sulcus region. In this class, the mandible and often the overlying cheek skin needs to be sacrificed, in addition to the contents of the infratemporal fossa and the posterior maxilla. Both the classes of resections are carried out in an orderly fashion following well-defined steps. These sequential steps maximize the exposure of inaccessible structures, enables protection of critical structures as well as minimizes blood loss. This manuscript describes the surgical steps for the two classes of compartmental resection of the infratemporal fossa for advanced gingivo-buccal complex cancers involving the masticatory space.
涉及咀嚼间隙（T4b）的晚期牙龈颊部复合癌的治疗通常采用分区切除术。目前该手术的肿瘤学安全性已明确确立。根据肿瘤的起源和中心，有两类分区切除术。一类是起源于上颌结节和/或上牙龈沟区域的肿瘤；切除范围包括肿瘤、上颌后部和同侧颞下窝。这些肿瘤可通过下颌骨切开术进行切除，保留下颌骨。这构成了1类颞下窝切除术。2类颞下窝切除术适用于起源于磨牙后三角和/或下牙龈颊沟区域的肿瘤。在这类手术中，除了颞下窝和上颌后部的内容物外，下颌骨以及通常覆盖的颊部皮肤也需要切除。两类切除术均按照明确的步骤有序进行。这些连续步骤可最大程度地暴露难以触及的结构，保护关键结构并减少失血。本文描述了针对涉及咀嚼间隙的晚期牙龈颊部复合癌的两类颞下窝分区切除术的手术步骤。
