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Combined approach for malignant tumours of the deep lobe of the parotid involving the stylomandibular tunnel and parapharyngeal space
  • Narayana Subramaniam,
  • Carsten Palme,
  • Tsu-Hui (Hubert) Low
Narayana Subramaniam
Chris O'Brien Lifehouse
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Carsten Palme
Chris O'Brien Lifehouse
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Tsu-Hui (Hubert) Low
Chris O'Brien Lifehouse
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Abstract

En-bloc clearance of malignant deep lobe parotid tumours involving the stylomandibular tunnel and parapharyngeal space is challenging in view of the limited surgical access and the critical structures that are located in close proximity The technique that we describe is a combined transmandibular-transmastoid approach that allows complete en-bloc resection of the deep parotid lobe and stylomandibular tunnel with a lateral temporal bone resection and a marginal mandibulectomy This approach provides good exposure of the critical structures and allows for a safe en-bloc resection and good oncological margins This clinical scenario is common in Australia, due to the high incidence of cutaneous squamous cell carcinoma involving the parotid gland, either through direct invasion or lymphatic spread In this article we explain step-by-step how to perform these resections to allow potential cure in patients with very locally advanced disease