Surgical approaches to the maxilla, maxillary sinus, pterygopalatine fossa, and infratemporal fossa for malignant tumors

The maxillary sinus cancers are the most frequent sinonasal malignancies, with the squamous cell carcinoma being the most common histology type. The typical up-front locoregional treatment includes transfacial, transoral, or endoscopic maxillectomy, with or without neck dissection, followed by reconstruction and adjuvant radiation therapy, to optimize local control. From an anatomical point of view, surgery of the maxilla represents a challenge, given its complex morphology and close relationships with the sinonasal cavities, the orbit, and the pterygopalatine and infratemporal fossae. The surgery of the maxilla may include a spectrum of procedures, ranging from the less invasive transnasal endoscopic techniques (used for benign tumors or small non-invading cancers limited to the maxillary sinus) to total transfacial maxillectomies, also extendable to the surrounding regions by orbital exenteration and posterior endoscopic resection of the pterygopalatine and infratemporal fossae. This chapter aims to describe, in a stepwise practical fashion, the main surgical techniques employed in the surgical control of maxillary sinus tumors. In particular, the modular endoscopic approaches, which can be tailored on each specific clinical condition, are described. The more radical open partial, subtotal, and total maxillectomies via the traditional transfacial or the less invasive transoral-transnasal approaches are also described.