The Cranio-orbitozygomatic Approach in the Management of Advanced Head and Neck Cancer

Objective: Report our experience with the use of the cranio-orbitozygomatic (COZ) approach in the management of advanced head and neck cancers and describe its use in the management of perineural invasion (PNI).

Methods: A retrospective chart review of patients that underwent a COZ approach for the treatment of advanced head and neck cancer with PNI at our tertiary care institution from August 2016 to November 2019 was performed. Twenty-three patients were included with a mean age of 63 (range: 23–80) most of which were male (n = 18).

Results: The most frequent malignancies treated included nine squamous cell carcinomas (39%), two adenoid cystic carcinomas (9%), and two anaplastic angiomas (9%). The rest of cancers (n = 10, 44%) were conformed of varied histologic subtypes including basosquamous carcinoma and osteosarcoma among others. Based on the AJCC 8th edition guidelines, most patients had T4 disease or greater (n = 17, 74%). Positive surgical margins were present in 61% and perineural invasion in 65% of patients. Radiotherapy and chemoradiotherapy were administered as adjuvant treatment in 48% (n = 11) and 17% (n = 4), respectively. Extensive composite surgical resections were performed on all patients most commonly including a maxillectomy (74%), infratemporal fossa resection (70%), lateral cavernous sinus resection (70%), orbital exenteration (65%), sphenoidotomy (48%), ethmoidectomy (48%), resection of middle cranial fossa floor (22%), and pterygopalatine fossa resection (17%). Defects were mainly reconstructed with microvascular free flaps (n = 18, 78%). In the immediate postoperative period, there was an overall complication rate of 18% (n = 4). There were no immediate postoperative deaths. Mean follow-up time was 12 months (range: 1–35). Thirty percent (n = 7) developed a recurrence (mean: 12 months, range: 2–32; five local, one regional, one distant). There was a 4% (n = 1) long-term mortality rate, with one patient passing away at 10 months. Collection of data is ongoing and further analysis of the data will be performed to elaborate on defined outcome measures.

Conclusion: The COZ approach is used for the radical resection of head and neck tumors. It presents a viable option for the management of tumors with a high risk of intradural spread with an acceptable complication rate and a low mortality rate.

Publication History

Article published online:
12 February 2021