Objective To evaluate the use of a combined lateral temporal fossa and intraoral
approach to resect palatal carcinomas and the use of a temporalis myofascial
flap for reconstruction.
Design Retrospective chart review of a case series.
Setting Tertiary university referral hospital.
Patients Sixteen patients underwent a combined approach for resection of palatal
carcinoma; 5 of the 16 were edentulous. Six types of tumors were treated:
adenoid cystic carcinoma (3 patients), low-grade mucoepidermoid carcinoma
(5 patients), squamous cell carcinoma (3 patients), polymorphous low-grade
adenocarcinoma (2 patients), osteosarcoma (1 patient), ameloblastoma (1 patient),
and hyalinizing clear cell carcinoma (1 patient).
Main Outcome Measures The postoperative diet, velum competence, flap viability, complications,
and survival.
Results Fifteen (94%) of 16 patients were able to resume their preoperative
diets. No velopharyngeal insufficiency was encountered. All flaps survived
and none required repeated surgical intervention. Five patients developed
serous otitis media and 2 patients required flap revision secondary to posterior
choanal obstruction. One patient died of complications unrelated to the procedure.
Conclusions A combined intraoral and lateral temporal fossa approach allows for
(1) en bloc resection of palatal malignancies along with resection of involved
pterygoid muscles, (2) isolation and resection of descending palatine nerves
and the proximal second division of the trigeminal nerve, and (3) primary
reconstruction of the palatal defect by means of the temporalis muscle rotated
into the operative defect. This method is especially useful in treating patients
with perineural spread of palatal carcinoma, and in those who are edentulous.
