Considerations on multiportal compartmental approach extended to the temporal fossa.

Purpose: To illustrate the applicability of compartmental surgery (CS) principles in the radical management of advanced oral cavity squamous cell carcinoma (OSCC) involving the high infratemporal fossa (ITF), in cases where neoadjuvant therapy is not feasible.

Methods: We report a case of recurrent OSCC of the retromolar trigone with extensive involvement of the masticatory space, including the medial and lateral pterygoid, masseter, and temporalis muscles. A multiportal surgical approach was employed, integrating a transnasal endoscopic route with extended transoral and transcervical corridors. Surgical steps followed the CS concept, including en-bloc resection of tumour spread pathways and musculature insertions.

Results: Radical resection including the involved masticatory musculature and temporalis muscle insertions was achieved. The final histopathology confirmed advanced-stage disease (rpT4b N3b R0 L1 V0 pn1 G2), with complete macroscopic and microscopic tumour removal.

Conclusion: This case supports the feasibility and oncologic efficacy of a CS-based multiportal approach in selected advanced OSCC involving the ITF. Further studies are needed to validate its role and define standardized protocols.