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Vol. 10. Issue 4.
Pages 265-276 (January 1999)
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Vol. 10. Issue 4.
Pages 265-276 (January 1999)
Abordajes infratemporales de la fosa infratemporal y de la rinofaringe
Infratemporal approaches of the infratemporal fossa and the nasopharynx
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L.A. García, C. Suárez Nieto
Servicio de O.R.L. Unidad de Cirugía de Base de Cráneo. Hospital Central de Asturias
R. Fernández de León*, B. Ruiz Moya*
* Servicio de Neurocirugía. Unidad de Cirugía de Base de Cráneo. Hospital Central de Asturias
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Resumen

Presentamos 55 pacientes con tumores que invaden la fosa infratemporal originados en la nasofaringe, seno maxilar, orofaringe, parótida y la propia fosa infratemporal que fueron operados entre 1988 y 1997, realizándose para ello 59 intervenciones (4 pacientes precisaron ser reintervenidos). Los abordajes utilizados fueron: el abordaje infratemporal con translocación facial (15 casos), el abordaje subtemporal-preauricular (12 casos), el abordaje transmandibular-transcervical (10 casos), la maxilectomía extendida a la fosa infratemporal (12 casos, 2 de los cuales combinaban una resección craneofacial de etmoides), la vía infratemporal transcavernosa (4 casos), la vía infratemporal tipo C de Fisch (2 casos) y el abordaje transmaxilar (4 casos), siendo necesaria la realización de craniectomía en 20 casos. Histológicamente, 43 tumores eran malignos, mientras que 12 eran benignos. La mayor parte de las lesiones eran de un gran tamaño afectando a gran parte de la base del cráneo. Se realizó una extirpación completa del tumor en 43 de los casos, siendo la resección subtotal en 12 tumores. Se utilizaron colgajos locales para el cierre del defecto tras la exéresis, utilizando predominantemente el músculo temporal. Las complicaciones postoperatorias más frecuentes consistieron en infecciones de la herida quirúrgica, fístulas de L.C.R. y epífora como consecuencia de la manipulación de la vía lacrimal. Cinco pacientes (9,1 %) fallecieron debido a complicaciones postoperatorias. En el momento actual 23 pacientes (41 %) han fallecido por progresión del tumor, 2 se encuentran vivos con enfermedad local, 23 pacientes están libres de enfermedad (41 %), 1 paciente falleció por otra causa y otro caso se perdió para el seguimiento.

Palabras Clave:
Fosa infratemporal
Base de cráneo
Tumores nasofaríngeos
Abordajes quirúrgicos infratemporales
Summary

Fifty five patients with neoplasms involving the infratemporal fossa and originating in the nasopharynx, the maxillary sinus, the oropharynx, parotid gland and the ipsilateral infratemporal fossa were managed between 1988 and 1997, using 59 surgical procedures (4 patients underwent a new operation). The surgical approaches used were: the infratemporal fossa approach with facial translocation (15 cases), the subtemporalpreauricular infratemporal approach (12 cases), the transmandibular-transcervical approach (10 cases), the extended maxillectomy (12 cases, 2 of them combined with craneofacial resection), the transcavernous infratemporal approach (4 cases), the infratemporal approach type C (2 cases) and the transmaxillary approach (4 cases). Twenty patients required craniectomy. Forty three tumors were malignant and twelve bening neoplasms. Most of the lesions were large involving multiple areas of the skull base. Tumor excision was total in 43 and subtotal in 12 cases. Local flaps were utilized to sealing the cavity after resection, using temporal muscle flaps predomimantly. The most frequent postoperative complications were wound infections, cerebrospinal leaks and epiphora, due to the transection of the lacrimal duct. Five patients (9,1 %) died as a result of postoperative complications. To date 23 patients (41 %) has died from tumor progression, 2 patients are alive with local disease, 23 patients (41 %) are alive without disease, 1 patient has died from other disease and 1 patient has been lost at the follow-up.

Key Words:
Infratemporal fossa
Skull base
Naso pharyngeal tumors
Infratemporal surgical approach

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