Aesthetic and Functional Aspects in Surgery of Parapharyngeal Space and Infratemporal Fossa Tumors

General Remarks: Surgery of the parapharyngeal space and the infratemporal fossa most frequently involves surgery of the skull base. It demands a complex skull base surgeon trained in oto-, rhino-, and head and neck, as well as practitioners of reconstructive plastic surgery. In addition, ability for interdisciplinary cooperation is a must, particularly if the tumor has grown intracranially. Functional Aspects: (1) Surgical approach should be both as small as possible and as extended as necessary. (2) Important neural and vascular structures should be preserved whenever possible. (3) One should think twice about temporary splitting of the mandible to widen the approach, particularly in children. (4) For bone reconstruction, autogenic material is cheaper and far superior to alloplastic material. (5) In benign lesions with a surgical capsule and no danger of tumor spread out, the enucleation technique helps for preservation of functionally important structures and minimizing the approach. (6) To operate as “functionally” as possible requires detailed knowledge about the biology of the great variety of skull base tumors. Aesthetic Considerations: (1) Preoperative shaving of hairs is not necessary. (2) Necessary incisions should be invisible as much as possible. (3) Using a combination of approaches helps to avoid major bone resection and disfigurement of facial skeleton. (4) For bone reconstruction, full thickness bone grafts taken from the temporal area allow for reconstruction of donor and recipient site. Approaches to the Lateral Skull Base: For cervical, direct lateral (transzygomatic), posteroinferior (infratemporal), and combined approaches to the skull base, use: midfacial degloving + transzygomatic, transoral + posteroinferior, transoral + cervical + transzygomatic and subcranial + transzygomatic. Conclusion: The value of these principles will be demonstrated with example cases.