Preauricular Infratemporal Fossa Surgical Approach: Modifications of the Technique and Surgical Indications

A retrospective clinical analysis was performed to evaluate the effectiveness of the preauricular infratemporal fossa (ITF) surgical approach using modifications based on tumor pathology and extension, without compromising outcomes. Patients were surgically treated for tumors involving the ITF via a preauricular surgical approach during 1990 to 2000. Their clinical charts were reviewed to determine the association among pathological variables, details of the surgical procedure, and outcomes. Tumors in 65 patients were categorized as “malignant” and “benign.” The malignant group included 44 patients (mean age, 49.5 years). Squamous cell carcinoma was the most common pathology followed by sarcomas. To achieve complete tumor resection, the ITF approach and dissection were combined with other procedures in 74% of these patients. No surgical complications were encountered in 74.4%, and a clinical cure was obtained in 55% of patients (follow-up, 2 years). The benign group included 21 patients (mean age, 36.7 years). Juvenile angiofibromas and meningiomas constituted most of the tumors in this group. An ITF approach alone was sufficient to achieve complete tumor excision in 66.7% of these patients. A clinical cure was achieved in 85% of patients (follow-up, 2 years), and 76.2% had no surgical complications. Chi-square tests revealed significant correlations between tumor extensions and surgical treatment variables. These were more evident in the malignant group, indicating the use of wider surgical exposures and more aggressive, extirpative surgery. The preauricular surgical approach to the ITF can be used to achieve a complete resection of a variety of tumors arising from or extending into the ITF. This approach can be tailored to the nature of the tumor and its extensions.

KEYWORDS

Skull base surgery - infratemporal fossa - preauricular approach

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This article analyzes a large series of cases involving surgical removal of both benign and malignant lesions via a preauricular infratemporal fossa approach. It is timely in that careful analysis of long-term outcomes is essential to validate extensive surgery, particularly for malignant lesions. A clinical cure was obtained in 55% of patients with malignant lesions at 2 years. In the benign group, a clinical cure was achieved in 85% of patients after the same period.

Longer follow-up, of course, is necessary to verify these outcomes. In the case of malignant lesions, recurrences often appear within 2 years, but re-review is necessary to validate disease-free survival of 5 years and longer. The same is true for the benign group.

Despite this shortcoming, this series demonstrates reasonable outcomes for an otherwise universally fatal disease with an acceptable morbidity rate and no mortality. I urge the authors to continue to follow these patients and to issue supplementary reports periodically.