Necrotizing fasciitis (NF) of the face is a rare yet serious condition requiring prompt and comprehensive management. This approach typically involves input from various medical specialties such as infectious disease specialists, critical care physicians, and surgeons. The primary goals are early recognition, aggressive surgical debridement, appropriate antibiotic therapy, and supportive care. Prompt diagnosis is crucial, based on symptoms like severe pain, rapidly spreading erythema, and systemic signs of infection. Broad-spectrum antibiotics are initiated empirically, and adjusted based on culture results. Urgent surgical debridement is crucial, removing all necrotic tissue. Careful consideration must be given to preserve vital structures. Close monitoring and intensive care may be necessary, especially for severe cases. Soft tissue reconstruction may follow once the infection is controlled, aiming to restore function and aesthetics. Long-term follow-up is essential to observe for complications and recurrence.

To analyse and report various aspects of lateral skull base surgery by describing the incidence and demographic variables, diagnostic and management challenges, surgical choices along with complications and their management and the long term morbidity and survival outcomes in our experience of 15 years. Retrospective review of complete records of all cases operated for lateral skull base tumors at a tertiary care teaching institution in India between timespan of 15 years from 2003 to 2018 was undertaken. 53 cases were selected and analysed. Those having follow up of less than 6 months were excluded. Outcomes were assessed in terms of incidence of types of tumors, benign or malignant, age and sex variation of the patients, staging status at presentation, status of facial and other lower cranial nerves pre-operatively, surgical techniques with complications if any, recurrences and survival. Of 35 benign tumors, tympanojugular paragangliomas were most common. Average age for these was 53 years with 19 females and 14 males. All were non-functional. Tinnitus and hearing loss were most common presentations. Class B2 and C1 tumors were most commonly encountered and the ITF A approach was most commonly used. Hearing loss and Facial palsy were commonest complication post-operatively. There were 2 recurrences. 18 malignancies were observed. Most were stage IV at presentation. Otorrhea and otalgia were most common presenting symptoms followed by hearing loss. 5 year survival was 55%. Successful treatment of lateral skull base lesions requires a multimodality therapy with team approach. Surgical resection is the primary management choice with variable approaches. ICA status related to the tumor is the most important consideration. Malignancies require more aggressive treatment for obtaining clear margins along with pre/post-op chemoradiation. Good results with acceptable complications can be obtained even with advanced tumors.

Atypical trigeminal schwannomas (ATSs) are notorious for their ability to invade the skull base. An expanded endoscopic endonasal approach (eEEA) provides direct access to the tumor with no need for cerebral retraction or manipulation of neurovascular structures. Herein, we present a case of a large temporal fossa extradural lesion with secondary invasion of the sella, clivus, and temporal and infratemporal fossae in a 49-year-old male with severe vision loss. A transpterygoid transmaxillary approach was performed. Gross-total removal was achieved and pathology revealed the diagnosis of ATS. Visual function fully recovered in the right side and the patient has been uneventfully followed since surgery. The video can be found here: https://youtu.be/6pSwdYsN9hk.

Approaching tumors involving the infratemporal fossa (ITF) is technically challenging due to the complex relationships between several neurovascular structures and the deep-seated location of these lesions.
The authors describe in detail a minimally invasive approach to the ITF, consisting on a single-nostril endoscopic endonasal transmaxillary approach aided by an anterior transmaxillary port (EEA-ATMa). Anatomical landmarks and surgical tenets of this approach are highlighted and reviewed with the goal to guarantee successful tumor resection and avoid operative complications.
The EEA-ATMa is technically feasible and offers excellent surgical exposure to the anterior and lateral aspect of ITF, without the need of transecting the Vidian nerve or performing a wide septectomy.

Cemento-ossifying fibroma is a benign fibro-osseous lesion of the jaws. Cemento-ossifying fibroma develops from the periodontal ligament and contains multipotent stem cells that can form cementum, lamellar bone, and/or fibrous tissue. These tumours occur in the third and fourth decades of life with higher predilection of occurrence in the female population and seldom attain a large size. We report a rare case of cemento-ossifying fibroma in a 45-year-old man involving the body of the mandible and extending into the para-pharyngeal and infratemporal region. This article describes the clinical, radiographic, and histological features of a large cemento-ossifying fibroma of the mandible.

Odontogenic myxoma (OM) is a rare locally invasive benign neoplasm, almost exclusively occurring in the jawbones, comprising 3-6% of all the odontogenic tumors. The mandible is more commonly involved than the maxilla. Intraoral soft tissue myxoma is an extremely rare lesion and only few reports are available in the literature. We present probably the first of its kind in literature a soft tissue OM occurring in an unusual location: the infratemporal fossa.

Background Intracranial dermoid cysts are rare tumors of congenital origin. We report a case of a large dermoid tumor arising in the infratemporal fossa (ITF) with erosion into the middle cranial fossa. After reviewing the literature, we believe this represents the first reported dermoid tumor of the ITF with extension into the middle cranial fossa. Results A 21-year-old women presented with a large cystic mass involving the left infratemporal fossa and middle cranial fossa that was discovered following a motor vehicle collision. Neurologic examination was normal. The mass was resected through a frontotemporal extradural approach with endoscopic assistance. Imaging studies, gross findings, and histopathology were consistent with a dermoid tumor. Conclusion This is the first report of a dermoid cyst arising in the ITF with extension into the middle cranial fossa. We suggest including dermoid tumor in the differential diagnosis of cystic abnormalities in this region. Complete resection of the cyst remains the preferred treatment with surgical approach guided by preoperative imaging.

Tumors occurring in the infratemporal region present a surgical challenge and access osteotomies of the facial skeleton is the answer to access these deeply situated, inaccessible tumors of the head and neck. Various approaches have been devised for their better exposure and it is our expertise as maxillofacial surgeons to provide surgical access by transmaxillary, transzygomatic and transmandibular approaches. We followed this concept in our institute and report here two case reports. The first is a 45-year-old female who presented with right facial pain and temporal swelling due to schwannoma in the right infratemporal region extending into middle cranial fossa. This was jointly treated by a team of neurosurgeons, maxillofacial surgeons and ENT surgeons by right temporal craniotomy, right transmandibular and transzygomatic approach. The second is a rare tumor occurring in a 26-year-old male with the chief complaint of right frontal headache and diplopia. The tumor was excised via access through the zygomatic arch and lateral orbital wall; diagnosed later as Rosai Dorfmans disease. No recurrence was seen at follow-up period of 2 years. These approaches help to reduce the surgical morbidity. Thus, oral and maxillofacial surgeons form a vital role in the multidisciplinary approach to provide access to difficult anatomic locations.