Skull base surgery in composite resection.

We extended the limits of standard jaw and neck dissection in large tumors of the oropharynx with extension to the soft and hard palate. Resection of the primary tumor with adequate margins and the lymphatics of the infratemporal fossa is required for tumor control in these extensive lesions. Splitting the lip in the midline and developing a large cervicofacial flap gives an excellent exposure to the region. The resection includes the hemimandible and the soft tissues of the intratemporal fossa. The internal carotid artery is followed to the skull base and all structures medial to this vessel, including the cartilaginous portion of the eustachian tube and the external carotid, are included in the en bloc specimen. The resection of the posterior maxilla, pterygoid plate, and palate may vary according to tumor size. The surgical defect is usually reconstructed with a pectoralis myocutaneous flap.