Alberto Schreiber1, Davide Mattavelli2, Remo Accorona3, Vittorio Rampinelli4, Marco Ferrari5, Alberto Grammatica4, Giovanni Leo Tomacelli6, Vincenzo Verzeletti5, Enrico Fazio7, Monir Abousiam7, Aurel Nebiaj7, Alberto Deganello2, Piero Nicolai5, Barbara Buffoli8, Rita Rezzani8, Cesare Piazza2, Luca Calabrese7. 1. Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy. Electronic address: dottor.schreiber@gmail.com. 2. Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 3. Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 4. Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy. 5. Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences University of Padua, Padua, Italy. 6. Unit of Otorhinolaryngology - Head and Neck Surgery, Vito Fazzi Hospital, Lecce, Italy. 7. Unit of Otorhinolaryngology, "San Maurizio" Hospital of Bolzano, Bolzano, Italy. 8. Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Abstract
OBJECTIVES: To present an anatomical cadaver dissection study and our preliminary surgical experience with endoscopic-assisted multi-portal compartmental resection of the masticatory space (MS) in locally advanced oral squamous cell carcinoma (OSCC) of the retromolar area. MATERIALS AND METHODS: Two fresh-frozen cadaver heads were dissected in the Laboratory of Anatomy to define the surgical steps of an endoscopic-assisted multi-portal compartmental approach to the MS. After this preclinical anatomical study, patients affected by locally advanced OSCC originating from the retromolar area with extension to the MS were prospectively enrolled and operated at two Italian referral centers for head and neck cancer between October 2019 and May 2020. RESULTS: Surgical technique of endoscopic-assisted multi-portal compartmental resection of the MS was preclinically defined step by step in 3 phases: transnasal, transoral/trancervical, and multi-portal. Compartmental resection of the MS was successfully completed in all specimens (4 MSs dissected). The surgical technique was subsequently applied in 3 patients affected by primary OSCC of the retromolar area, providing satisfactory results in terms of negative resection margins and local control. CONCLUSIONS: Multi-portal compartmental resection of the MS combining the transnasal and transoral/transcervical corridors is technically feasible. Such an approach to the MS in locally advanced OSCC provides different angles of incidence to the target and full control of tumor margins.
OBJECTIVES: To present an anatomical cadaver dissection study and our preliminary surgical experience with endoscopic-assisted multi-portal compartmental resection of the masticatory space (MS) in locally advanced oral squamous cell carcinoma (OSCC) of the retromolar area. MATERIALS AND METHODS: Two fresh-frozen cadaver heads were dissected in the Laboratory of Anatomy to define the surgical steps of an endoscopic-assisted multi-portal compartmental approach to the MS. After this preclinical anatomical study, patients affected by locally advanced OSCC originating from the retromolar area with extension to the MS were prospectively enrolled and operated at two Italian referral centers for head and neck cancer between October 2019 and May 2020. RESULTS: Surgical technique of endoscopic-assisted multi-portal compartmental resection of the MS was preclinically defined step by step in 3 phases: transnasal, transoral/trancervical, and multi-portal. Compartmental resection of the MS was successfully completed in all specimens (4 MSs dissected). The surgical technique was subsequently applied in 3 patients affected by primary OSCC of the retromolar area, providing satisfactory results in terms of negative resection margins and local control. CONCLUSIONS: Multi-portal compartmental resection of the MS combining the transnasal and transoral/transcervical corridors is technically feasible. Such an approach to the MS in locally advanced OSCC provides different angles of incidence to the target and full control of tumor margins.