Combined median mandibulotomy and Weber-Fergusson maxillectomy

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Advanced maxillary sinus carcinoma often requires combined modality treatment, including surgery and radiotherapy.
• The Weber-Fergusson approach is standard but has limitations in accessing posterior tumor extensions into the infratemporal and pterygopalatine fossae.
• Existing alternative approaches, such as temporal or lateral infratemporal fossa routes, involve complex osteotomies or zygomatic arch mobilization.

Observation:

• This study introduces a modified surgical technique for advanced maxillary sinus carcinoma involving posterior extension.
• The technique combines the classic Weber-Fergusson approach with a median labiomandibulotomy, extending along the floor of the mouth.
• This allows for lateral rotation of the coronoid process, providing improved visualization and access to the posterior infratemporal fossa.

Findings:

• The median labiomandibulotomy extension facilitates superior surgical exposure of the infratemporal fossa to its posterior extent.
• Two cases of advanced maxillary sinus carcinoma with posterior extension were successfully treated using this combined approach.
• Complete resection of the lesions was achieved, demonstrating the efficacy of this technique for challenging anatomical locations.

Implications:

• This combined surgical approach offers a viable alternative for achieving complete resection in advanced maxillary sinus cancers with posterior invasion.
• It potentially improves oncological outcomes by enabling more comprehensive tumor extirpation compared to standard methods.
• Further studies may explore the broader applicability and long-term results of this technique in head and neck oncology.