The extended maxillotomy and subtotal maxillectomy for excision of skull base tumors.

An approach to tumors of the middle compartment of the skull base is described with three case reports. It is accomplished by extending the subtotal maxillectomy or maxillotomy to include removal of a part of the malar bone, coronoid process of the mandible, nasal turbinates, ethmoid and sphenoid sinuses, posterior nasal septum, and pterygoid plates. Extension of the incision through the anterior tonsillar pillar and lateral pharyngeal wall into the retropharyngeal space will assist to expose the craniocervical region from the sphenoid roof to the fifth cervical vertebra and the skull base between each eustachian tube and carotid canal. The function of the trigeminal, facial, and hypoglossal nerves, hearing, and nasal airway are preserved without mastoidectomy. A temporalis muscle flap closes the defect. Dysphagia and aspiration are not handicaps.

Skull base surgery for glomus jugulare tumors.

Thirty-six patients with glomus jugulare tumors have been managed over a 13-year period using various combinations of skull base surgery and irradiation therapy. The data resulting from this study are presented; the techniques of diagnosis and treatment are reviewed. We conclude that irradiation therapy alone is a satisfactory form of treatment for elderly and poor-risk patients; preoperative x-ray therapy followed by skull base surgery is an effective treatment for younger patients.

Glomus jugulare tumours--combined treatment: part I.

Total en bloc removal is the ideal surgical treatment for glomus jugulare tumours. Efforts to accomplish this have been made periodically since shortly after this tumour was first identified in the early 1940s. A method of removal using a combined approach through the neck and temporal bone is described here. This method is preceded by pre-operative irradiation therapy and on occasion by embolization. The early results obtained using this method in 19 patients are reported.

Combined approach surgery for removal of glomus jugulare tumors.

The ideal surgical treatment for glomus jugulare tumors is total removal. Efforts have been made periodically to accomplish this since shortly after this tumor was first identified in the early 1940's. This paper describes a method of removal using a combined approach through the neck and temporal bone, preceded by a course of preoperative irradiation therapy. The early results that have been obtained using this procedure in 10 patients are reported.

Symposium: management of tumors of the parotid gland.

The successful management of swellings in the parotid gland region is dependent upon the establishment of a clinical and/or histologic diagnosis of the condition responsible for the production of the abnormal swelling. All mobile parotid tumors are removed as an excisional biopsy with preservation of the facial nerve. A preoperative biopsy will not influence the subsequent management of these lesions. An aspiration biopsy is employed to evaluate all primary, previously undiagnosed, non-ulcerative parotid tumors suspected of being clinically malignant. An experienced pathologist views with confidence evaluation of solid material that has been carefully separated from the aspirated specimen. It is our opinion that when the biopsy tract is removed with the tumor, there is less risk of surgical wound contamination by tumor than when there is an incisional biopsy or incomplete excision of the tumor for frozen or permanent section diagnosis. One should not expect to derive as much information from an aspiration biopsy as may be derived from a formal incisional biopsy. If the histologic interpretation of the aspirated material is inconclusive, one may proceed to accept the added risk of an open biopsy. If it is known preoperatively that the tumor is malignant, that it is other than a low grade cancer, and that the tumor should be treated surgically, management of the facial nerve and the cervical nodes may be anticipated. This may be accomplished by an aspiration biopsy.