Facial nerve and mandible conservative approach for lesions in the infratemporal fossa and base of the middle skull

At our Center, desquamation/enucleation is performed using a cervical approach as a basic procedure for primary parapharyngeal neoplastic lesions. However, operation on a tumor on the basilar side must inevitably be performed blindly, and if the affected region involves middle basilar bone, or is a wide-ranging lesion toward the infratemporal fossa, there is a very limited visual field for sparing the facial nerve during operation. In such cases we develop resection sparing the facial nerve, zygomatic arch and mandible without facial skin incision by adding an approach from the anterolateral retromaxillary pathway via the gingivobuccal sulcus or subtemporal approach. The dead space resulting from enucleation of the tumor will be selected and filled by free-flap or most appropriately selected local for each case. The surgical technique is described herein. This procedure is mainly for benign tumors but is also effective for low-grade tumors.