Surgical management of buccal cancer involving masticator space
Buccal cancer involving masticator space grows rapidly and penetrates well with a high recurrence rate due its aggressive nature. The local recurrence rate is very high, and many patients are treated with palliative intent because of their eventual poor outcome. Results are poor because of inability to achieve negative margins in three dimensions. Also, the surgical clearance is difficult because of the extent of tumour spread in masticator space. Cancers originating from the masticator space, pterygoid plates or skull base, invade adjacent anatomical structures, thus surgical tumour resection becomes very challenging.
The present case describes the surgical management of a 55 year-old man who presented with lesions in the inner cheek. The masticator space involvement made the physical examination difficult. CT and MRI revealed a buccal mucosa tumour that had invaded the retroantral space. Since. there are several natural anatomic holes through which the masticator space communicates with adjacent structures, the tumor growth is rapid and penetration is high.
Dr. Mathan and his team have a sound experience in management of tumours involving masticator spaces. Dr. Mathan did a radical (compartmental) surgical approach to access the masticator space behind the maxillary sinus. The aim of radical surgical approach was to improve the likelihood of obtaining negative margins.
Buccal-cancer involving masticator-space (T4b) is a very difficult problem due to the fact that the masticator space is one of the deep compartments of the head and neck. Familiarity with the anatomy of the masticator space and its anatomic relationship with adjacent structures is important for a radical (compartmental) surgical approach and in the management of tumours involving masticator spaces.