INFRATEMPORAL FOSSA SURGERY FOR MALIGNANT DISEASES

The improvement in the knowledge of the main anatomical landmarks perm its an evolution in the safety of the surgical treatment and a concept ual development of the geometrical anatomico-surgical characteristics of the infratemporal fossa. This conceptual evolution determines surgi cal and oncological advantages: firstly, improved comprehension of the anatomico-surgical limits of the resection and secondly the safeguard ing of the oncological ''en-bloc'' dissection. The lateral approach of the infratemporal fossa gives a wider exposure of the surgical field, a shorter depth of work, a good control over the vessels and the poss ibility of carry out a microsurgical transfer. The surgical approaches correspond to the topographical location and the biology of the neopl asm in cases with infratemporal fossa and inferior compartment locatio n the lateral transfacial approach is indicated. In cases with involve ment of the superior compartment a lateral transcraniofacial subtempor al approach is necessary in order to remove the skull base. In cases w ith a neoplastic invasion of the skull base where the dura mater is th e anatomical plane free from disease it is necessary to utilize an int radural approach, In patients with a secondary spread into the inferio r compartment from the maxilla a combined antero-lateral transfacial a pproach is indicated. Finally, an orbitomaxillary involvement with sec ondary spread in the upper compartment of the infratemporal fossa nece ssitates an antero-lateral transcraniofacial subtemporal subfrontal ap proach.