Mini-invasive transoral surgical approach to the medial compartment of the masticator space for venous malformations and benign tumours removal

Abstract

Background. This article describes a new surgical technique to approach venous malformation and benign tumors located in the medial compartment of masticator space. Methods. A 50-year-old female referred painless swelling of buccal mucosa above the medial surface of right ramus. CT scan and MRI imaging suggested a neuroma-like lesion. Radiological examination could not determine the nature of the lesion, and a convincing diagnosis could not be achieved. Considering the focal bone erosion at mandibular notch, the uncertain diagnosis, and especially the impossibility to exclude other benign lesions of the masticator space, the patient underwent surgical removal of the lesion. Results. The hypothesized neuroma turned out to be a venous malformation, clinically and histologically confirmed. When the diagnosis is uncertain, only histological examination determines the true nature of the lesion. The presently described technique considered mouth opening issues: when mandibular ramus rotates and moves forward, the coronoid process is anatomically close to the tuber maxillae. Therefore, there isn't enough space to approach the medial compartment of the masticator space unless coronoid process is temporarily removed. L-shaped osteotomy of the coronoid process is mini-invasive, safe and comfortable. Coronoidotomy offers a wide field of vision and allows easy access transorally to the masticator space. Conclusions. Combined mandibular coronoidotomy, with or without endoscopic magnification, is a suitable approach to treat a well-defined lesion in the medial compartment of the masticator space with mandibular ramus involvement; intralesional injection of n-butyl-2-cyanoacrylate in venous malformation completes the surgical procedure in a predictable and safe way.