Discussion
This technique is an effective combined approach to resect large
malignant tumours involving the stylomandibular tunnel, parapharyngeal
and masticator spaces with adequate circumferential oncological margins
in a safe and controlled manner. Although the stylomandibular tunnel is
a narrow area with potential spread to the pre-styloid parapharyngeal
space and masticator space, an appropriate mandibulotomy permits
sufficient anterior exposure with concurrent lateral temporal bone
resection and enough posterior exposure to allow malignant tumours in
this region to be removed safely.
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 (4). Similarly, this
technique can be utilized in malignant primary parotid lesions that have
extended through the stylomandibular tunnel, into the parapharyngeal and
masticator spaces.
Most of these malignant tumours would either present with facial nerve
weakness or encasement of some component of the facial nerve,
necessitating a concurrent resection of the facial nerve and
reconstruction wherever possible.