Modified Lateral Surgical Approach to the Pterygopalatine Fossa for Safe Preservation of the Peripheral Branch of the Marginal Mandibular Nerve

In cases where oral cancer spreads toward the maxillary tubercle, surgery may extend to the pterygopalatine fossa. There are 2 main extraoral approaches: anterior and lateral. Previously, we introduced a modified lateral approach with a mouth corner incision from the lower lip, that preserves the mental and marginal mandibular nerves. Now, we present a further modification that allows safer preservation of the peripheral branches of the marginal mandibular nerve around the mouth. The procedure has 2 key points. The first is to follow the course of the marginal mandibular nerve from the submandibular incision. The second is to begin the mouth corner incision from the upper lip. Deploying the cheek flap ensured the marginal mandibular nerve was contained within a preserved platysma band. The postoperative contours and unremarkable scar on the face were acceptable to the patient. Paralysis of the facial and mental nerves was almost nonexistent. In conclusion, this newly modified lateral approach is useful in fully exposing the pterygopalatine fossa while preserving the mental nerve and not only the main trunks of the marginal mandibular nerves but also the peripheral branches around the mouth.