Subcranial craniotomy in surgical management of advanced oral cavity malignancies: a technical note

Craniofacial resection is the technique of choice for tumors of the oral cavity or paranasal sinus extending close to the skull base of middle cranial fossa. Here we would like to describe a new technique of approaching these tumors through the facial incision itself.

All patients treated with this technique at our institute were included in this retrospectively analyzed case series. The pathological clearance margins, complications and outcomes were studied.

A total of nine patients underwent resection of tumor with the subcranial approach. There were seven males and two female patients. Mean age was 50.66 years (22–72 years). The diagnosis was squamous cell carcinoma in five patients, adenoid cystic carcinoma in three patients and alveolar soft part sarcoma in one patient. A lip split incision and mandibulotomy/mandibulectomy was done in seven patients; a Weber–Fergusson incision was used in one patient and details were not available in one other patient. Reconstruction was done with anterolateral thigh flaps with or without titanium mesh for all the patients. One patient developed thalamic infarct and was managed conservatively. None of the other patients had complications related to the craniotomy. The infratemporal fossa margin was close/involved in two patients (22.22%). Eight patients received adjuvant therapy without delay. One patient, who had received radiation previously, did not receive adjuvant radiation.

This technique aims to reduce morbidity without compromising on the oncological outcomes for tumors extending short of or up to the skull base.