Combined median mandibulotomy and Weber-Fergusson maxillectomy

Monoblock surgical resection in combination with radiotherapy remains the most effective method of treatment for advanced carcinoma of the maxillary sinus. Extension of antral carcinoma into the infratemporal and pterygopalatine fossae decreases the probability of achieving an all-encompassing resection via the classic anterolateral Weber-Fergusson approach because of limited posterior access. Temporal and lateral infratemporal fossa approaches have been described and involve either mobilization of the zygomatic arch or a lateral mandibular osteotomy, respectively. We report the use of a median labiomandibulotomy combined with the Weber-Fergusson approach for lesions extending posteriorly. The labiomandibulotomy with paralingual extension along the floor of the mouth allows rotation of the coronoid process laterally and exposes the infratemporal fossa to its posterior margin. We present two cases in which this approach was used to extirpate lesions that had extended posteriorly. Relevant anatomy, operative technique, potential complications, and limitations, as well as a comparison with other methods of exposure, are discussed.