Mandibular swing procedure for resection of pharyngeal and skull base tumors

Objective: To seek for a better approach for the resection of pharyngeal and skull base tumors.

Methods: The overall tumor distribution for the entire group was nasopharyngeal 2 cases, oropharyngeal 4, parapharyngeal space 5 and parapharyngeal infratemporal area 2 cases. All 13 cases of pharyngeal and skull base tumors had their tumors thoroughly resected via mandibular swing approaches. Five cases had retropharyngeal node dissections, 2 cases had unilateral modified radical neck dissections, 5 cases with defect oropharynx were reconstructed with the pectoralis major myocutaneous flap, 10 cases with malignant tumors had received adjutant radiotherapy after surgical procedures.

Results: Of the 13 cases, 10 were malignant, 3 were benign. The incision in 12 cases healed primarily, one case with malignant fibrocystic tumor got infective necrosis of pectoralis major myocutaneous flap, this case healed completely after more than two months. One case developed dysphagia postoperatively and was recovered by swallow training. One case had minimal occlusion disorder. All patients were followed up from 15 months to 3 years. Three cases with benign tumors achieved good clinical results and are living well. In the malignant group, one died of recurrence at 6 months postoperatively, one died of lung metastasis, 2 cases survived for 3 years, 2 for two years, 4 for one year.

Conclusions: This procedure provides good exposure of the base of the skull, the pharynx and the parapharyngeal space as well as the clivus and upper cervical vertebrae; it allows dissection along the internal carotid artery and facilitates resection of the tumor en bloc. It provides operative safety and minimal morbidity.