Surgical management of primary and secondary tumors in the pterygopalatine fossa.

OBJECTIVE: This article describes a surgical approach that has been applied to managing primary tumors in the pterygopalatine fossa and secondary tumors involving the pterygopalatine fossa. PATIENTS AND METHODS: The Barbosa approach was modified by adding a lateral incision in the mandibular gingivobuccal fold from the canine tooth to the retromolar area. This technique was applied to nine patients with primary and secondary tumors in the pterygopalatine fossa. All patients had been observed by clinical examinations, MRI, and CT examinations. RESULTS: This technique allowed a large, inferiorly based flap to be raised, which includes the parotid gland. The masseter and temporalis muscles were divided horizontally, and the ascending ramus of the mandible was osteotomied between the mandibular angle and the sigmoid notch and reflected to expose the tumor in the pterygopalatine fossa and maxillary sinus. We have applied this technique in 9 patients. Of the 9 patients in our study, 5 (55%) were male and 4 (45%) were female. The median age of the patients at the time of operation for primary and secondary tumors in the pterygopalatine fossa was 49.5 years (range, 19-66 years). Four of the 9 patients had primary tumors in the pterygopalatine fossa. One patient had a tumor in the pterygoaplatine fossa extending into the maxillary sinus, 2 patients had tumors occurring in the maxilla involving the pterygopalatine fossa, 2 patients had tumors from the deep lobe of the parotid gland to the pterygopalatine fossa, and 1 patient had extracranial meningioma. Nine patients have been followed up from 3 months to 9 years and 6 months, and 1 patient had recurrence 2 years and 2 months postoperatively. CONCLUSION: This technique is especially useful to tumors in the pterygopalatine fossa and tumors in the pterygopalatine fossa extending into the maxillary sinus.