By Charles Staley (Editor), John E. Skandalakis (Editor), Sean Moore William C. Wood (Editor)
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Additional resources for Anatomic Basis of Tumor Surgery, 2nd Edition
The osteotomy is performed in a stair-step fashion as previously described. Lateral distraction of the anterior and posterior mandibular segments allows exposure to the lingual gingiva, which is transected and the soft tissue resection performed as needed. This approach allows good access to the lateral posterior ﬂoor of mouth, posterior tongue and tongue base, tonsil, and soft palate. It also provides good access to the parapharyngeal space. After soft tissue resection is completed, the defect is closed with either primary closure, split-thickness skin grafting, or a ﬂap.
After this, the lateral pharyngotomy is initiated. The hypoglossal nerve is identiﬁed and followed anteriorly to its entrance into the ﬂoor of mouth lateral to the hyoglossus muscle. The hypoglossal nerve is freed circumferentially from its surrounding venous structures. The overlying posterior belly of the digastric and stylohyoid muscles is transected. The ansa hypoglossi branch of the hypoglossal nerve is transected. This allows the hypoglossal nerve to be retracted superiorly out of the ﬁeld.
The anterior border is formed by the pterygomandibular raphe. The lateral boundaries are the medial pterygoid muscle, the mandible, the portion of the deep lobe of the parotid gland, and a small portion of the digastric muscle posteriorly. The posterior border is the prevertebral fascia. The parapharyngeal space is divided into a prestyloid and a poststyloid compartment by fascia extending from the styloid process to the tensor veli palatini muscle. The prestyloid compartment contains lymphatic tissue, the internal maxillary artery, and branches of the mandibular division of the trigeminal nerve.