Surgical Technique for Compartmental Resection of T4b Gingivobuccal Cancer

Management of advanced gingivo-buccal complex cancers involving the masticatory space (T4b) is often managed by compartment resection. The oncological safety of the procedure is now clearly established. Based on the origin and epicenter of the tumor there are two classes of compartmental resection. Those tumors arising from the tuberosity of the maxilla and/or upper gingival sulcus region; the resection involves the tumor, posterior maxilla, and the ipsilateral infratemporal fossa. These tumors can be resected by mandibulotomy approach, preserving the mandible. This constitutes class-1 infratemporal fossa resection. The class-2 infratemporal fossa resection is applied for those tumors arising from the retromolar trigone and/or lower gingivo-buccal sulcus region. In this class, the mandible and often the overlying cheek skin needs to be sacrificed, in addition to the contents of the infratemporal fossa and the posterior maxilla. Both the classes of resections are carried out in an orderly fashion following well-defined steps. These sequential steps maximize the exposure of inaccessible structures, enables protection of critical structures as well as minimizes blood loss. This manuscript describes the surgical steps for the two classes of compartmental resection of the infratemporal fossa for advanced gingivo-buccal complex cancers involving the masticatory space.