Vol.:(0123456789) 1 3 Oral Cancer (2018) 2:91–96 https://doi.org/10.1007/s41548-018-0013-0 ORIGINAL ARTICLE Subcranial craniotomy in surgical management of advanced oral cavity malignancies: a technical note Hamsa Nandini 1  · Kiran Mariswamappa 2  · Naveen Hedne 3  · Srikamakshi Kothandaraman 4  · Akanksha Saxena 5  · Vijay Pillai 3  · Vivek Shetty 3  · R. Vidyabhushan 3  · Komal Prasad 2  · Moni Abraham Kuriakose 6 Received: 11 March 2018 / Accepted: 5 August 2018 / Published online: 22 August 2018 © Springer Nature Switzerland AG 2018 Abstract Purpose 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. Methods 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. Results 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 fve patients, adenoid cystic carcinoma in three patients and alveolar soft part sarcoma in one patient. A lip split incision and mandibul- otomy/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 faps 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. Conclusions This technique aims to reduce morbidity without compromising on the oncological outcomes for tumors extend- ing short of or up to the skull base. Keywords Infratemporal fossa carcinoma · Craniofacial resection · T4b oral cancer · Peri neural spread · Carcinoma buccal mucosa · Carcinoma maxilla Introduction Malignancies of the oral cavity or paranasal sinuses extend- ing into the infratemporal fossa (ITF) and skull base are a common presentation in most tertiary cancer centers. The most common pathologies include the squamous cell carci- noma (SCC), sarcoma and adenoid cystic carcinoma (ACC) [1]. These tumors are treated by a craniofacial resection (CFR) with acceptable outcomes. This procedure is riddled with its own set of complications mostly due to the crani- otomy. Few of the commonly encountered ones are stroke, partial or total fap failure, wound dehiscence, cerebrospinal fuid (CSF) leak, fstula, major artery rupture, temporal lobe edema or contusion due to retraction, meningitis and pneu- mocephalus [2, 3]. To reduce the morbidity of the formal craniotomy, we have devised a new surgical technique. We * Kiran Mariswamappa kiranmam2000@gmail.com 1 Halamma Kerudi Cancer Hospital, Bagalkot, India 2 Department of Neurosurgery, Mazumdar-Shaw Medical Center, Narayana Health City, 258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore 560099, India 3 Department of Head and Neck Oncology, Mazumdar-Shaw Medical Center, Narayana Health City, Bangalore, India 4 Cancer Institute (WIA), Adyar, Chennai, India 5 Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, Delhi, India 6 Department of Surgical Oncology, Mazumdar-Shaw Medical Center, Narayana Health City, Bangalore, India