Comparison of perioperative indices and postoperative complications between two surgical treatments for benign tumours in the infratemporal parapharyngeal space: Mandibular ascending branch longitudinal osteotomy versus paramedian osteotomy

Comparison of perioperative indices and postoperative complications between two surgical treatments for benign tumours in the infratemporal parapharyngeal space: Mandibular ascending branch longitudinal osteotomy versus paramedian osteotomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of perioperative indices and postoperative complications between two surgical treatments for benign tumours in the infratemporal parapharyngeal space: Mandibular ascending branch longitudinal osteotomy versus paramedian osteotomy ZHU Hao, Zhao Xiaowen, Zheng Mengjie, Zhang Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4007499/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This was a retrospective analysis of perioperative indicators and postoperative complications of ascending branch longitudinal osteotomy versus paramedian osteotomy for treating patients with benign tumours. The aim was to provide a reference for the surgical treatment of benign tumours in the infratemporal parapharyngeal space. Methods: Clinical medical records and imaging data for 58 patients with benign tumours in the infratemporal parapharyngeal region admitted to the Oral and Maxillofacial Surgery Department of the General Hospital of Northern Theater Command were collected from November 2010 to June 2023. 28 patients underwent mandibular median osteotomy (Group A) and 30 patients underwent mandibular ascending branch longitudinal osteotomy (Group B) for the treatment of benign tumours. Comparative analysis of intraoperative bleeding, operation time, and postoperative complications between the two groups was conducted using the t test and chi-square test. Results: The intraoperative blood loss and operation time in Group B were significantly lower than those in Group A (p <0.05), and the incidence of postoperative complications such as limited mouth opening, gap infection, and nerve injury was significantly lower than that in Group A (p <0.05). Patients were followed up from June to December. Postoperatively, temporary mouth opening was limited, the reduction in masticatory function gradually returned to the normal level within approximately 1-3 months, and facial nerve damage returned to normal within approximately 3-6 months after surgery. Conclusion: 1. When the tumour is confined to the infratemporal parapharyngeal space, ascending longitudinal osteotomy has the advantages of less intraoperative bleeding, less surgical time and fewer postoperative complications. 2. Paramedian osteotomy is more suitable when a tumour in the infratemporal parapharyngeal region invades the pterygopalatine fossa upwards, grows beyond the trailing edge of the maxilla backwards, or invades the skull base downwards. infratemporal fossa parapharyngeal space benign tumour mandibular osteotomy surgical approach Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The infratemporal parapharyngeal space is the general term for the infratemporal fossa and the parapharyngeal space of the lateral skull base region. Because this anatomical area is hidden and deep and separated by bony structures such as the mandible and zygomatic arch, the clinical symptoms are often hidden, early diagnosis is difficult, patients often have large tumours, and even some tumours invade the skull [1,2] . Currently, surgery is the preferred treatment for tumours in the infratemporal parapharyngeal region [ 3 , 4 ] . Since this area involves multiple disciplines, there are dozens of surgical approaches, and mass resection approaches closely related to oral and maxillofacial surgery include the lateral approach [ 5 ] and the anterior approach [ 6 ] and different approach exposure ranges and degrees of trauma [ 7 ] . Obtaining a good surgical field and preserving important structures to minimize postoperative functional damage are serious challenges [ 8 ] . In this study, the clinical data for 58 patients admitted to the Oral and Maxillofacial Surgery Department of the General Hospital of Northern Theater Command were summarized and analysed to provide a reference for clinical surgery. Materials and methods 1.1 Inclusion and exclusion criteria 1.1.1 Inclusion criteria (1) According to preoperative CT, MRI, CTA, DSA and other imaging methods, the scope of tumour lesions was limited to the infratemporal parapharyngeal region. (2) Paramedian osteotomy of the mandible or ascending longitudinal osteotomy of the mandible was performed; (3) The postoperative pathological result was a benign tumour. 1.1.2 Exclusion criteria (1) Patients with tumours in the infratemporal parapharyngeal region treated by other surgical methods; (2) Patients whose pathological result was of vascular origin; (3) Patients with abnormal coagulation function; (4) Patients with facial paralysis and mouth opening limitations for other reasons; (5) No follow-up investigation was possible. 1.2 Clinical data Of the 58 patients included, 41 were female and 17 were male; all were aged 9–66 years, and the mean age was 54 years. In Group A, 6 patients were male, and 22 were female, and the patients had a mean age of 52.2 years; in Group B, 19 patients were female, and 11 were male, and the patients had a mean age of 55.9 years. All the tumours were completely removed; 37 patients had pleomorphic adenoma (63.80%), 4 had (6.90%), 14 had (24.20%), 2 had neurofibromas (3.40%), and 1 had myoepithelioma (1.70%). Most patients in the two groups were found to have headache, facial swelling and discomfort, limited mouth opening, abnormal swallowing, or incidental findings during the examination of other diseases. 1.3 Preoperative examination Preoperative examinations included electronic computerized tomography (CT), nuclear magnetic resonance (MRI), CT angiography, and electronic fibre laryngoscopy. 1.4 Surgical methods 1.4.1 Longitudinal osteotomy of the ascending branch of the mandible The surgical approach involved the conventional submandibular approach or pre-ear screen-submandibular approach; that is, a curved incision was made 1.5-2 cm below the mandibular edge and the ascending branch surface of the mandible, the osteotomy segment was pulled back, the anterior mandible was pushed forwards to reveal the tumour（Fig.1）, the tumour was separated along the capsule, and complete resection was performed. After determining that the occlusal relationship was stable, the lower jaw ascending branch was reset and fixed with a titanium plate and titanium nail（Fig.2）. A negative pressure drain was placed, and the incision was sutured. Elastic intermaxillary traction was performed after surgery. 1.4.2 Paramedian osteotomy of the mandible The surgical approach was the submandibular approach; that is, an arc incision was made 1.5-2 cm below the mandibular margin, with the incision extending to the lower lip. Inside the mouth, the incision and the buccal vestibular groove were connected with the labial incision, and the mandible was truncated between the incisor and the fangs. The tumour was exposed（Fig.3）, separated along the capsule, and removed intact. After the occlusal relationship was stabilized, the mandible was reduced, a titanium plate and titanium nail were fixed（Fig.4）, the internal incision was tightly closed, a negative pressure drainage tube was placed, and the facial and neck incisions were closed. Elastic intermaxillary traction was performed after surgery. 1.5 Postoperative follow-up Regular outpatient reviews were performed in January, March and June, and imaging examination data and telephone inquiries were obtained. 1.6 Evaluation indices Statistical assessments of intraoperative blood loss, operation time, postoperative mouth limitation, nerve injury, space infection and other complications were performed for Group A and Group B. 1.7 Statistical analysis SPSS Statistics 21 software was used to apply the statistical processing and analysis. The normal Shapiro‒Wilk test showed that the variance in the two sample sizes was large and significantly different; therefore, the corrected t test was used. Results In both groups, the mandible was broken during surgery, and patients required intermaxillary traction for 1 month with stable occlusion. Three patients in Group A developed postoperative mouth floor space infection, and all patients with postoperative mouth space infection were discharged after recovery. One of them had sensory numbness in 2/3 of the affected tongue, which was considered to pull the tongue nerve when stripping the floor tissue of the mouth during surgery. The tongue numbness disappeared at the 3-month follow-up. Four patients developed severe or moderate mouth opening limitations and were instructed to practice mouth opening after intermaxillary traction, and one of four patients developed lower lip deviation. In addition, three patients had lower lip deviation after surgery, without progressive aggravation after surgery, and the symptoms of facial nerve injury recovered after postoperative follow-up. In Group B, 2 patients developed lower lip deviation, and 2 patients had moderate mouth limitations. One patient was considered to have nerve injury of the lower alveolar nerve due to numbness in the gingiva and lower lip. Six months after the operation, the range of numbness was lower than before. 2.1 Comparison of intraoperative blood loss and operation time between the two groups The intraoperative blood loss and operation time in Group B were significantly less than those in Group A. The α was 0.05 (P <0.05) (Table 1). 2.2 Comparison of postoperative complications between the two groups The incidence of postoperative complications in Group B was significantly lower than that in Group A, and the chi-square test was performed (P <0.05) (Table 2). Follow-up for more than 6 months revealed no deaths in either group, 1 relapse in Group A and 2 relapses in Group B. 2.3 Comparison of preoperative and postoperative chewing efficiency between the two groups The chewing efficiency of the two groups was compared before and 3 months after surgery. According to the statistical analysis, there was no significant difference (P> 0.05) (Table 3), indicating that the postoperative masticatory function in both groups had returned to the preoperative level. Discussion The infratemporal parapharyngeal region is the general term for the two adjacent gaps, the infratemporal fossa and the parapharyngeal space, with the pharyngeal motor and veins, the IX-XII and the cranial nerves. The lateral skull base area comprises honeycomb tissue accompanying the vascular nerve that extends into adjacent spaces [ 9 , 10 ] ; thus, the infratemporal fossa and parapharyngeal space can communicate with each other through anatomical characteristics, and they are often regarded as the same anatomical area for analysis and discussion. Clinically, we refer to tumours that invade the infratemporal parapharyngeal space as invading the infratemporal parapharyngeal region, where tumours are very rare, accounting for only 0.5-1.0% of head and neck tumours [ 11 ] . Patients with primary benign tumours in the infratemporal fossa and parapharyngeal space generally have no obvious or self-conscious symptoms in the initial stage. Early detection is mostly accidental during head and facial craniocerebral imaging examination due to other symptoms of head and facial discomfort, such as headache [ 12 ] . Currently, the preferred treatment for benign tumours in the infratemporal fossa and parapharyngeal space is surgery. According to the literature [9 ， 10][9 ， 10] [13 ， 14] , the anterior ear screen-submandibular approach is a widely used surgical approach combined with different osteotomy methods for the mandible [ 15 ] . [11] For surgical treatment of tumours in the hypopharyngeal region, methods such as longitudinal osteotomy of the ascending branch, median osteotomy of the mandible, and mandibular angle osteotomy are used. Median osteotomy of the mandible has gradually been replaced by secondary osteotomy due to the high risk of root injury and destruction of the floor muscle tension of the mouth. Mandibular angle osteotomy will cause irreversible damage to the lower alveolar nerve, resulting in numbness of the lower lip after surgery, and the use of this technique has decreased in recent years. Several scholars [1 6 ] have reported that longitudinal osteotomy of the ascending branch is a relatively simple operation and causes little surgical trauma in the removal of benign tumours from the inferior temporal hypopharyngeal region, but the surgical field exposure is relatively limited [1 7 ] . Scholars worldwide have indicated that tumours involving the inferior temporal fossa, parapharyngeal space and deep lobe of the parotid gland can be fully exposed and that the symptoms of temporary nerve injury caused by traction and pulling can also be resolved after surgery. However, median mandibular osteotomy is associated with greater trauma and more postoperative complications than longitudinal osteotomy of the ascending branch [1 8 ] , but Spiro [1 9 ] reported that fully exposing the lateral skull base area, including the infratemporal parapharyngeal region, reduces damage to the facial nerve and the inferior alveolar nerve, which is a better and safer surgical method for treating tumours of the infratemporal parapharyngeal area. Based on the above characteristics, this study compared the advantages and disadvantages of ascending longitudinal osteotomy and paramedian osteotomy in terms of anatomical and clinical effects. 3.1 Mandibular ascending branch longitudinal osteotomy Advantages: This operation generates minimal trauma, the vascular nerves of the deep surface are clearly separated, and the pulling damage of the facial nerve and the mandibular nerve and postoperative occlusion disorder are reduced. The surgical incision does not communicate with the oropharynx, and the risk of postoperative infection is low. The postoperative scar is hidden. Disadvantages: The operation requires dissection of the superficial muscles of the mandibular masseter area and the medial muscle of the inner side of the ascending branch. It takes some time for the masticatory muscle to reattach after surgery, which leads to a decrease in masticatory function for a period of time after surgery. In addition, due to the limitations of the incision of the submandibular tract and the obstruction of the mandible, the view of the tumour in the front and lower areas is insufficient. 3.2 Paramedian osteotomy of the mandible Advantages: This strategy can prevent damage to the inferior alveolar nerve, maintain the muscle tension balance at the bottom of the mouth, and reduce postoperative damage to speech function. It can maximize the parapharyngeal space, inferior temporal fossa, pterygopalatine fossa, eustachian tube area, prevertebral space to jugular vein orifice and other skull base parts. Disadvantages: The surgical wound is large, and the chin and lower lip skin scars are obvious. The wound communicates with the mouth, turning the sterile wound into a contaminated wound. The resection line is located between the two roots, which may cause postoperative malocclusion, poor bone healing, and root damage. Tandon [ 20 ] suggested that the internal carotid artery should be pushed to the bottom of the skull only when the tumour diameter is greater than 8 cm, but according to the present study, when the simple submandibular approach is used or combined with the mandible approach, even if the tumour size is less than 8 cm, Paramedian osteotomy is also a suitable option to reduce surgical risk. 3.3 Comparison of the surgical exposure range between the two groups (1) Anterior and upper: The leading edge of the infratemporal parapharyngeal region is the back of the maxilla. When the tumour is confined to the infratemporal parapharyngeal region, the leading edge of the tumour can be safely dissected by blunt separation, but attention should be given to protecting the wing vein plexus to reduce intraoperative bleeding. However, when the tumour invades the anterior and superior wing and palate socket, there is zygomatic arch obstruction and coracoid obstruction on the lateral side, and the visual field and operation range are relatively limited. The tumours were isolated under blind vision, with greater injury risk to the maxillary nerve, pterygopalatine ganglion, and maxillary artery. Moreover, mandibular median osteotomy can be used to expose the inferior temporo-parapharyngeal area from the mouth, anatomically protect important neuroblood vessels, reduce the risk of intraoperative bleeding, and reduce the possibility of haemostasis difficulties. (2) Lower part: Under the infratemporal parapharyngeal area, an inverted cone is formed by the hyoid lingual muscle, hyoid muscle, distal abdomen, upper pharynx constrictor muscle, pterus muscle and other soft tissues, with the level of the hyoid bone serving as the lower boundary. When the tumour is confined to the infratemporal parapharyngeal region and longitudinal osteotomy of the mandibular ascending branch is used, the tumour can be successfully removed after blunt stripping of the soft tissue around the tumour in the absence of other surrounding bony structures. If the tumour overflows below and breaks into the wing mandibular space, the anterior extension of the mandible is not enough to safely separate the anterior edge of the tumour under direct vision. At this time, mandibular osteotomy is used to rotate the mandible and expose the wing mandibular space under direct vision, thus fully exposing the location of the tumour and safely separating the tumour. (3) Upper part: the upper boundary of the infratemporal parapharyngeal region is the inferior temporal and inferior temporal ridge of the sphenoid major wing, and the upper margin of the zygomatic arch is at the same level as the petrous part of the temporal bone. When the tumour invades the skull base area upwards, the longitudinal osteotomy of the mandible is limited due to the root of the zygomatic arch. The incision can be extended upwards to the temporal region and temporarily off the zygomatic arch so that the side fully exposes the deep area and skull base area. According to the relevant literature [ 21 ] , the length of the zygomatic arch is approximately 32.9±2.6 mm, which can be regarded as exposing the inferior temporal fossa transverse diameter length after truncating the zygomatic arch. However, paramedian osteotomy of the mandible can pass from the inner mouth through the parapharyngeal space and separate the internal jugular arterial vein near the edge of the tumour and the IX-XII nerves under direct vision, which is a safer surgical option. There are some limitations in this study. Due to the limited conditions in the operating room, CT or C-arm X-ray imaging could not be performed during the operation, and the angle of the tumour could not be calculated or analysed in the horizontal, coronal or sagittal images. Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of the General Hospital of the Northern Theater Command [Approval No.: Y(2023)210]. Consent for publication Since this study is a retrospective study, the informed consent application is waived after approval by the Medical Ethics Committee of the General Hospital of the Northern Theater Command. Availability of data and materials All of the data and materials will be available from the corresponding author upon request. Competing interests The authors declare no competing interests. Funding This study received no financial support. Authors’contributions ： Zhang Li conceived and designed this study. Zhu Hao and Zheng MJ performed data collection and analysis. Zhu Hao and Zhao Xiaowen wrote the paper. Zhu Hao and Zhao Xiaowen contributed equally to this work and should be regarded as joint first authors. All authors read and approved the final manuscript. References Sharma P K , Massey B L . Avoiding Pitfalls in Surgery of the Neck, Parapharyngeal Space, and Infratemporal Fossa[J]. Otolaryngologic Clinics of North America, 2005, 38(4):795-808. Khafif A , Segev Y , Kaplan D M , et al. Surgical management of parapharyngeal space tumors: A 10-year review[J]. Otolaryngology - Head and Neck Surgery, 2005, 132(3):401-406. Gao Zhiqiang.Technique system in lateral skull base surgery[J].Chinese Journal of Otorhinolaryngol Head Neck Surgery,2018,53(6):401-405. Zhang M, Garvis W, Linder T,et al. Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma[J].Laryngoscope,1998,108(11):1717-1723. Fisch U, Fagan P, Valavanis A, et al. The infratemporal fossa approaches for the lateral skull base[J]. Otolaryngologic Clinics of North America, 1984, 17(3):513-552. GUOChuan-bin. Surgical approch selection of parapharyngeal subtemporal tumors involving the skull base[J].Chinese Journal of Stomatology, 2006, 41 (8): 467-469. Yen Zhouxi, Yang Chi, Chen Minjie. Surgical approaches to temporromandibular joint tomor involving infratemporal space[J]. Chinese Journal of Stomatology Reseach,2015, 9(2):3. Bilsky MH, Bentz B, Vitaz T, et al. Craniofacial resection for cranial base malignaneies involving the infratemporal fossa[J].Neurosurgery,2005,57(4):339-347. Van Huijzen C. Anatomy of the skull base and the infratemporal fossa. Neuro-Otology and Skull Base Surgery. Switzerland: Karger Publishers, 1984: 242-253. Yu Q, Wang P, Shi H, et al. Central skull base invasion of maxillofacial tumors: computed tomography appearance. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2000, 89 (5): 643-650. Stell P, Mansfield AO, Stoney P. Surgical approaches to tumors of the parapharyngeal space. American journal of otolaryngology, 1985, 6 (2): 92-97. Tao Lei, Shi Xiaoling,LI Xiaoming.Retrospective analysis of 188 cases of parapharyngeal space tumors[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018, 32 (2): 129-133. Luna-Ortiz K , Villa-Zepeda O , Carrillo J F , et al. Parapharyngeal Space Tumor: Submandibular Approach Without Mandibulotomy[J]. Journal of Maxillofacial & Oral Surgery, 2016, 94(4):911-911. Lombardi D , Ferrari M , Paderno A , et al. Selection of the surgical approach for lesions with parapharyngeal space involvement: A single-center experience on 153 cases[J]. Oral Oncology, 2020, 109:104872. Riffat F, Dwivedi RC, Palme C, et al. A systematic review of 1143 parapharyngeal space tumors reported over 20 years. Oral oncology, 2014, 50 (5): 421-430. Zhao Zhen-zhen，Song Jian-xing. Anatomy structure characteristics of mandibular angle region and minimally invasive incision at the auricuIocephalic sulcus[J].Journal of Clinical Rehabilitative Tissue Engineering Research, 2009, 13 (7): 1301-1304. Chatni SS, Sharan R, Pater D, et al.Transmandibular approach for excision of maxillary sinus tumors extending to pterygopalatine and infratemporal[J].Oral Oncol,2009,45(8):720-726. Hang Gang,Lu Li,Liu Ying. The treatment of large tumor in parotid deep lobe by paramedian mandibulotomy approach.[J].Journal of practical stomatology,2011, 27 (4): 565-567. Spiro RH, Spiro JD, Strong EW. Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth. Head Neck Surg, 1986, 9(1): 27-31. Tandon D A , Bahadur S , Misra N K , et al. Parapharyngeal neurofibromas[J]. Journal of Laryngology & Otology, 1992, 106(03):243-246. Jiang Jian，Liu Ning，Zhu Fengyi，et al. Anatomy of Bony Structure and Clinical Significance of the Subtemporal Transmandibular Approach[J].Progress of Anatomical sciences,2005, 11 (2): 102-104. Tables Table 1 Comparison of intraoperative blood loss and operation time Group Example number (person) Amount of bleeding (ml) Time of surgery (min) Group A 28 287.14±68.82 349.11±38.969 Group B 30 152.50±30.22 207.00±4.292 9.531 16.671 P <0.001 <0.001 Table 2 Comparison of postoperative complications Group Example number Gap infection Limitation of mouth opening Facial nerve injury Other neurological injuries Total complications [n (%)] Group A 28 3 4 4 1 12(42.86) Group B 30 0 2 2 1 5(16.67) χ 2 4.80 P 0.03 Table 3 Chewing efficiency in both groups before and after surgery group Example number (person) Preoperative (%) Postoperative (%) Group A 28 72.41±4.36 .8723±4.40 Group B 30 73.90±5.52 73.87±5.37 t 0.23 0.17 P 0.92 0.87 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4007499","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":278170886,"identity":"39f55b88-3e1c-40ca-801a-488457e73184","order_by":0,"name":"ZHU Hao","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"ZHU","middleName":"","lastName":"Hao","suffix":""},{"id":278170887,"identity":"4c199ce0-5680-478e-9a59-39d4de6d1d46","order_by":1,"name":"Zhao Xiaowen","email":"","orcid":"","institution":"General Hospital of Northern Theater 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18:39:31","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":14893,"visible":true,"origin":"","legend":"","description":"","filename":"Rawdatasummary.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4007499/v1/9d82ff44ef420bdc7bb0edba.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of perioperative indices and postoperative complications between two surgical treatments for benign tumours in the infratemporal parapharyngeal space: Mandibular ascending branch longitudinal osteotomy versus paramedian osteotomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe infratemporal parapharyngeal space is the general term for the infratemporal fossa and the parapharyngeal space of the lateral skull base region. Because this anatomical area is hidden and deep and separated by bony structures such as the mandible and zygomatic arch, the clinical symptoms are often hidden, early diagnosis is difficult, patients often have large tumours, and even some tumours invade the skull\u003csup\u003e[1,2]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCurrently, surgery is the preferred treatment for tumours in the infratemporal parapharyngeal region\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Since this area involves multiple disciplines, there are dozens of surgical approaches, and mass resection approaches closely related to oral and maxillofacial surgery include the lateral approach\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and the anterior approach\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e6\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and different approach exposure ranges and degrees of trauma\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Obtaining a good surgical field and preserving important structures to minimize postoperative functional damage are serious challenges\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e8\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. In this study, the clinical data for 58 patients admitted to the Oral and Maxillofacial Surgery Department of the General Hospital of Northern Theater Command were summarized and analysed to provide a reference for clinical surgery.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Inclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1.1 Inclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) According to preoperative CT, MRI, CTA, DSA and other imaging methods, the scope of tumour lesions was limited to the infratemporal parapharyngeal region.\u003c/p\u003e\n\u003cp\u003e(2) Paramedian osteotomy of the mandible or ascending longitudinal osteotomy of the mandible was performed;\u003c/p\u003e\n\u003cp\u003e(3) The postoperative pathological result was a benign tumour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1.2 Exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Patients with tumours in the infratemporal parapharyngeal region treated by other surgical methods;\u003c/p\u003e\n\u003cp\u003e(2) Patients whose pathological result was of vascular origin;\u003c/p\u003e\n\u003cp\u003e(3) Patients with abnormal coagulation function;\u003c/p\u003e\n\u003cp\u003e(4) Patients with facial paralysis and mouth opening limitations for other reasons;\u003c/p\u003e\n\u003cp\u003e(5) No follow-up investigation was possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Clinical data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 58 patients included, 41 were female and 17 were male; all were aged 9\u0026ndash;66 years, and the mean age was 54 years. In Group A, 6 patients were male, and 22 were female, and the patients had a mean age of 52.2 years; in Group B, 19 patients were female, and 11 were male, and the patients had a mean age of 55.9 years. All the tumours were completely removed; 37 patients had pleomorphic adenoma (63.80%), 4 had (6.90%), 14 had (24.20%), 2 had neurofibromas (3.40%), and 1 had myoepithelioma (1.70%). Most patients in the two groups were found to have headache, facial swelling and discomfort, limited mouth opening, abnormal swallowing, or incidental findings during the examination of other diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Preoperative examination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreoperative examinations included electronic computerized tomography (CT), nuclear magnetic resonance (MRI), CT angiography, and electronic fibre laryngoscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Surgical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4.1 Longitudinal osteotomy of the ascending branch of the mandible\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe surgical approach involved the conventional submandibular approach or pre-ear screen-submandibular approach; that is, a curved incision was made 1.5-2 cm below the mandibular edge and the ascending branch surface of the mandible, the osteotomy segment was pulled back, the anterior mandible was pushed forwards to reveal the tumour（Fig.1）, the tumour was separated along the capsule, and complete resection was performed.\u0026nbsp;After determining that the occlusal relationship was stable, the lower jaw ascending branch was reset and fixed with a titanium plate and titanium nail（Fig.2）.\u0026nbsp;A negative pressure drain was placed, and the incision was sutured. Elastic intermaxillary traction was performed after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4.2 Paramedian osteotomy of the mandible\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe surgical approach was the submandibular approach; that is, an arc incision was made 1.5-2 cm below the mandibular margin, with the incision extending to the lower lip. Inside the mouth, the incision and the buccal vestibular groove were connected with the labial incision, and the mandible was truncated between the incisor and the fangs. The tumour was exposed（Fig.3）, separated along the capsule, and removed intact. After the occlusal relationship was stabilized, the mandible was reduced, a titanium plate and titanium nail were fixed（Fig.4）, the internal incision was tightly closed, a negative pressure drainage tube was placed, and the facial and neck incisions were closed. Elastic intermaxillary traction was performed after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Postoperative follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegular outpatient reviews were performed in January, March and June, and imaging examination data and telephone inquiries were obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.6 Evaluation indices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical assessments of intraoperative blood loss, operation time, postoperative mouth limitation, nerve injury, space infection and other complications were performed for Group A and Group B.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.7 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS Statistics 21 software was used to apply the statistical processing and analysis. The normal Shapiro‒Wilk test showed that the variance in the two sample sizes was large and significantly different; therefore, the corrected t test was used.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn both groups, the mandible was broken during surgery, and patients required intermaxillary traction for 1 month with stable occlusion. Three patients in Group A developed postoperative mouth floor space infection, and all patients with postoperative mouth space infection were discharged after recovery. One of them had sensory numbness in 2/3 of the affected tongue, which was considered to pull the tongue nerve when stripping the floor tissue of the mouth during surgery. The tongue numbness disappeared at the 3-month follow-up. Four patients developed severe or moderate mouth opening limitations and were instructed to practice mouth opening after intermaxillary traction, and one of four patients developed lower lip deviation. In addition, three patients had lower lip deviation after surgery, without progressive aggravation after surgery, and the symptoms of facial nerve injury recovered after postoperative follow-up. In Group B, 2 patients developed lower lip deviation, and 2 patients had moderate mouth limitations. One patient was considered to have nerve injury of the lower alveolar nerve due to numbness in the gingiva and lower lip. Six months after the operation, the range of numbness was lower than before.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Comparison of intraoperative blood loss and operation time between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intraoperative blood loss and operation time in Group B were significantly less than those in Group A. The \u0026alpha; was 0.05 (P \u0026lt;0.05) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Comparison of postoperative complications between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of postoperative complications in Group B was significantly lower than that in Group A, and the chi-square test was performed (P \u0026lt;0.05) (Table 2). Follow-up for more than 6 months revealed no deaths in either group, 1 relapse in Group A and 2 relapses in Group B.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Comparison of preoperative and postoperative chewing efficiency between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe chewing efficiency of the two groups was compared before and 3 months after surgery. According to the statistical analysis, there was no significant difference (P\u0026gt; 0.05) (Table 3), indicating that the postoperative masticatory function in both groups had returned to the preoperative level.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe infratemporal parapharyngeal region is the general term for the two adjacent gaps, the infratemporal fossa and the parapharyngeal space, with the pharyngeal motor and veins, the IX-XII and the cranial nerves. The lateral skull base area comprises honeycomb tissue accompanying the vascular nerve that extends into adjacent spaces\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e10\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e; thus, the infratemporal fossa and parapharyngeal space can communicate with each other through anatomical characteristics, and they are often regarded as the same anatomical area for analysis and discussion.\u003c/p\u003e\n\u003cp\u003eClinically, we refer to tumours that invade the infratemporal parapharyngeal space as invading the infratemporal parapharyngeal region, where tumours are very rare, accounting for only 0.5-1.0% of head and neck tumours\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e11\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Patients with primary benign tumours in the infratemporal fossa and parapharyngeal space generally have no obvious or self-conscious symptoms in the initial stage. Early detection is mostly accidental during head and facial craniocerebral imaging examination due to other symptoms of head and facial discomfort, such as headache\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e12\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCurrently, the preferred treatment for benign tumours in the infratemporal fossa and parapharyngeal space is surgery. According to the literature\u003csup\u003e[9\u003c/sup\u003e\u003csup\u003e，\u003c/sup\u003e\u003csup\u003e10][9\u003c/sup\u003e\u003csup\u003e，\u003c/sup\u003e\u003csup\u003e10]\u003c/sup\u003e\u003csup\u003e[13\u003c/sup\u003e\u003csup\u003e，\u003c/sup\u003e\u003csup\u003e14]\u003c/sup\u003e, the anterior ear screen-submandibular approach is a widely used surgical approach combined with different osteotomy methods for the mandible\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e15\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003csup\u003e[11]\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eFor surgical treatment of tumours in the hypopharyngeal region, methods such as longitudinal osteotomy of the ascending branch, median osteotomy of the mandible, and mandibular angle osteotomy are used. Median osteotomy of the mandible has gradually been replaced by secondary osteotomy due to the high risk of root injury and destruction of the floor muscle tension of the mouth. Mandibular angle osteotomy will cause irreversible damage to the lower alveolar nerve, resulting in numbness of the lower lip after surgery, and the use of this technique has decreased in recent years. Several scholars\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e6\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e have reported that longitudinal osteotomy of the ascending branch is a relatively simple operation and causes little surgical trauma in the removal of benign tumours from the inferior temporal hypopharyngeal region, but the surgical field exposure is relatively limited\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Scholars worldwide have indicated that tumours involving the inferior temporal fossa, parapharyngeal space and deep lobe of the parotid gland can be fully exposed and that the symptoms of temporary nerve injury caused by traction and pulling can also be resolved after surgery. However, median mandibular osteotomy is associated with greater trauma and more postoperative complications than longitudinal osteotomy of the ascending branch\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e8\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e, but Spiro\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003ereported that fully exposing the lateral skull base area, including the infratemporal parapharyngeal region, reduces damage to the facial nerve and the inferior alveolar nerve, which is a better and safer surgical method for treating tumours of the infratemporal parapharyngeal area. Based on the above characteristics, this study compared the advantages and disadvantages of ascending longitudinal osteotomy and paramedian osteotomy in terms of anatomical and clinical effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Mandibular ascending branch longitudinal osteotomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdvantages: This operation generates minimal trauma, the vascular nerves of the deep surface are clearly separated, and the pulling damage of the facial nerve and the mandibular nerve and postoperative occlusion disorder are reduced. The surgical incision does not communicate with the oropharynx, and the risk of postoperative infection is low. The postoperative scar is hidden.\u003c/p\u003e\n\u003cp\u003eDisadvantages: The operation requires dissection of the superficial muscles of the mandibular masseter area and the medial muscle of the inner side of the ascending branch. It takes some time for the masticatory muscle to reattach after surgery, which leads to a decrease in masticatory function for a period of time after surgery. In addition, due to the limitations of the incision of the submandibular tract and the obstruction of the mandible, the view of the tumour in the front and lower areas is insufficient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Paramedian osteotomy of the mandible\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdvantages: This strategy can prevent damage to the inferior alveolar nerve, maintain the muscle tension balance at the bottom of the mouth, and reduce postoperative damage to speech function. It can maximize the parapharyngeal space, inferior temporal fossa, pterygopalatine fossa, eustachian tube area, prevertebral space to jugular vein orifice and other skull base parts.\u003c/p\u003e\n\u003cp\u003eDisadvantages: The surgical wound is large, and the chin and lower lip skin scars are obvious. The wound communicates with the mouth, turning the sterile wound into a contaminated wound. The resection line is located between the two roots, which may cause postoperative malocclusion, poor bone healing, and root damage.\u003c/p\u003e\n\u003cp\u003eTandon\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e20\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e suggested that the internal carotid artery should be pushed to the bottom of the skull only when the tumour diameter is greater than 8 cm, but according to the present study, when the simple submandibular approach is used or combined with the mandible approach, even if the tumour size is less than 8 cm, Paramedian osteotomy is also a suitable option to reduce surgical risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Comparison of the surgical exposure range between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Anterior and upper: The leading edge of the infratemporal parapharyngeal region is the back of the maxilla. When the tumour is confined to the infratemporal parapharyngeal region, the leading edge of the tumour can be safely dissected by blunt separation, but attention should be given to protecting the wing vein plexus to reduce intraoperative bleeding. However, when the tumour invades the anterior and superior wing and palate socket, there is zygomatic arch obstruction and coracoid obstruction on the lateral side, and the visual field and operation range are relatively limited. The tumours were isolated under blind vision, with greater injury risk to the maxillary nerve, pterygopalatine ganglion, and maxillary artery. Moreover, mandibular median osteotomy can be used to expose the inferior temporo-parapharyngeal area from the mouth, anatomically protect important neuroblood vessels, reduce the risk of intraoperative bleeding, and reduce the possibility of haemostasis difficulties.\u003c/p\u003e\n\u003cp\u003e(2) Lower part: Under the infratemporal parapharyngeal area, an inverted cone is formed by the hyoid lingual muscle, hyoid muscle, distal abdomen, upper pharynx constrictor muscle, pterus muscle and other soft tissues, with the level of the hyoid bone serving as the lower boundary. When the tumour is confined to the infratemporal parapharyngeal region and longitudinal osteotomy of the mandibular ascending branch is used, the tumour can be successfully removed after blunt stripping of the soft tissue around the tumour in the absence of other surrounding bony structures. If the tumour overflows below and breaks into the wing mandibular space, the anterior extension of the mandible is not enough to safely separate the anterior edge of the tumour under direct vision. At this time, mandibular osteotomy is used to rotate the mandible and expose the wing mandibular space under direct vision, thus fully exposing the location of the tumour and safely separating the tumour.\u003c/p\u003e\n\u003cp\u003e(3) Upper part: the upper boundary of the infratemporal parapharyngeal region is the inferior temporal and inferior temporal ridge of the sphenoid major wing, and the upper margin of the zygomatic arch is at the same level as the petrous part of the temporal bone. When the tumour invades the skull base area upwards, the longitudinal osteotomy of the mandible is limited due to the root of the zygomatic arch. The incision can be extended upwards to the temporal region and temporarily off the zygomatic arch so that the side fully exposes the deep area and skull base area. According to the relevant literature\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e21\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, the length of the zygomatic arch is approximately 32.9\u0026plusmn;2.6 mm, which can be regarded as exposing the inferior temporal fossa transverse diameter length after truncating the zygomatic arch. However, paramedian osteotomy of the mandible can pass from the inner mouth through the parapharyngeal space and separate the internal jugular arterial vein near the edge of the tumour and the IX-XII nerves under direct vision, which is a safer surgical option.\u003c/p\u003e\n\u003cp\u003eThere are some limitations in this study. Due to the limited conditions in the operating room, CT or C-arm X-ray imaging could not be performed during the operation, and the angle of the tumour could not be calculated or analysed in the horizontal, coronal or sagittal images.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of the General Hospital of the Northern Theater Command [Approval No.: Y(2023)210].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince this study is a retrospective study, the informed consent application is waived after approval by the Medical Ethics Committee of the General Hospital of the Northern Theater Command.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll of the data and materials will be available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo;contributions\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhang Li conceived and designed this study. Zhu Hao and Zheng MJ performed data collection and analysis. Zhu Hao and Zhao Xiaowen wrote the paper. Zhu Hao and Zhao Xiaowen contributed equally to this work and should be regarded as joint first authors. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSharma P K , Massey B L . Avoiding Pitfalls in Surgery of the Neck, Parapharyngeal Space, and Infratemporal Fossa[J]. Otolaryngologic Clinics of North America, 2005, 38(4):795-808.\u003c/li\u003e\n\u003cli\u003eKhafif A , Segev Y , Kaplan D M , et al. Surgical management of parapharyngeal space tumors: A 10-year review[J]. Otolaryngology - Head and Neck Surgery, 2005, 132(3):401-406.\u003c/li\u003e\n\u003cli\u003eGao Zhiqiang.Technique system in lateral skull base surgery[J].Chinese Journal of Otorhinolaryngol Head Neck Surgery,2018,53(6):401-405.\u003c/li\u003e\n\u003cli\u003eZhang M, Garvis W, Linder T,et al. 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Anatomy structure characteristics of mandibular angle region and minimally invasive incision at the auricuIocephalic sulcus[J].Journal of Clinical Rehabilitative Tissue Engineering Research, 2009, 13 (7): 1301-1304.\u003c/li\u003e\n\u003cli\u003eChatni SS, Sharan R, Pater D, et al.Transmandibular approach for excision of maxillary sinus tumors extending to pterygopalatine and infratemporal[J].Oral Oncol,2009,45(8):720-726.\u003c/li\u003e\n\u003cli\u003eHang Gang,Lu Li,Liu Ying. The treatment of large tumor in parotid deep lobe by paramedian mandibulotomy approach.[J].Journal of practical stomatology,2011, 27 (4): 565-567.\u003c/li\u003e\n\u003cli\u003eSpiro RH, Spiro JD, Strong EW. Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth. Head Neck Surg, 1986, 9(1): 27-31.\u003c/li\u003e\n\u003cli\u003eTandon D A , Bahadur S , Misra N K , et al. Parapharyngeal neurofibromas[J]. Journal of Laryngology \u0026amp; Otology, 1992, 106(03):243-246.\u003c/li\u003e\n\u003cli\u003eJiang Jian，Liu Ning，Zhu Fengyi，et al. Anatomy of Bony Structure and Clinical Significance of the Subtemporal Transmandibular Approach[J].Progress of Anatomical sciences,2005, 11 (2): 102-104.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Comparison of intraoperative blood loss and operation time\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExample number (person)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount of bleeding (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime of surgery (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e287.14\u0026plusmn;68.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e349.11\u0026plusmn;38.969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e152.50\u0026plusmn;30.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e207.00\u0026plusmn;4.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"36\" height=\"37\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e9.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e16.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Comparison of postoperative complications\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.405643738977073%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.81657848324515%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExample number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.75485008818342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGap infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638447971781305%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLimitation of mouth opening\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.052910052910052%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFacial nerve injury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.520282186948853%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther neurological injuries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.811287477954146%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal complications [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.405643738977073%\" valign=\"top\"\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.81657848324515%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.75485008818342%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638447971781305%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.052910052910052%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.520282186948853%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.811287477954146%\" valign=\"top\"\u003e\n \u003cp\u003e12(42.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.405643738977073%\" valign=\"top\"\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.81657848324515%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.75485008818342%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638447971781305%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.052910052910052%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.520282186948853%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.811287477954146%\" valign=\"top\"\u003e\n \u003cp\u003e5(16.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.405643738977073%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.81657848324515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.75485008818342%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638447971781305%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.052910052910052%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.520282186948853%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.811287477954146%\" valign=\"top\"\u003e\n \u003cp\u003e4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.405643738977073%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.81657848324515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.75485008818342%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.638447971781305%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.052910052910052%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.520282186948853%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.811287477954146%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Chewing efficiency in both groups before and after surgery\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003egroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExample number (person)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e72.41\u0026plusmn;4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e.8723\u0026plusmn;4.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e73.90\u0026plusmn;5.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e73.87\u0026plusmn;5.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.545454545454547%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"infratemporal fossa, parapharyngeal space, benign tumour, mandibular osteotomy, surgical approach","lastPublishedDoi":"10.21203/rs.3.rs-4007499/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4007499/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e This was a retrospective analysis of perioperative indicators and postoperative complications of ascending branch longitudinal osteotomy versus paramedian osteotomy for treating patients with benign tumours. The aim was to provide a reference for the surgical treatment of benign tumours in the infratemporal parapharyngeal space.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eClinical medical records and imaging data for 58 patients with benign tumours in the infratemporal parapharyngeal region admitted to the Oral and Maxillofacial Surgery Department of the General Hospital of Northern Theater Command were collected from November 2010 to June 2023. 28 patients underwent mandibular median osteotomy (Group A) and 30 patients underwent mandibular ascending branch longitudinal osteotomy (Group B) for the treatment of benign tumours. Comparative analysis of intraoperative bleeding, operation time, and postoperative complications between the two groups was conducted using the t test and chi-square test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe intraoperative blood loss and operation time in Group B were significantly lower than those in Group A (p \u0026lt;0.05), and the incidence of postoperative complications such as limited mouth opening, gap infection, and nerve injury was significantly lower than that in Group A (p \u0026lt;0.05). Patients were followed up from June to December. Postoperatively, temporary mouth opening was limited, the reduction in masticatory function gradually returned to the normal level within approximately 1-3 months, and facial nerve damage returned to normal within approximately 3-6 months after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e 1. When the tumour is confined to the infratemporal parapharyngeal space, ascending longitudinal osteotomy has the advantages of less intraoperative bleeding, less surgical time and fewer postoperative complications. 2. Paramedian osteotomy is more suitable when a tumour in the infratemporal parapharyngeal region invades the pterygopalatine fossa upwards, grows beyond the trailing edge of the maxilla backwards, or invades the skull base downwards.\u003c/p\u003e","manuscriptTitle":"Comparison of perioperative indices and postoperative complications between two surgical treatments for benign tumours in the infratemporal parapharyngeal space: Mandibular ascending branch longitudinal osteotomy versus paramedian osteotomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-14 18:39:26","doi":"10.21203/rs.3.rs-4007499/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"da19ad4e-11ac-465c-927e-af5ff30b41ae","owner":[],"postedDate":"March 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-02T11:42:24+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-14 18:39:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4007499","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4007499","identity":"rs-4007499","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}