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