The combined compartmental maxillary resection: technique codification and preliminary multicenter series analysis

Purpose: Maxillary cancers extending to the deep craniofacial spaces represent one of the most challenging scenarios in head and neck oncology. Integrating compartmental surgery principles with combined endoscopic–open approaches may optimize deep-margin control, a key determinant of oncologic radicality. Methods: A retrospective analysis included 34 patients treated between 2019 and 2025 at four referral centers using combined compartmental maxillary resection (CCMR). Procedures were assigned to CCMR types 1–3 according to the compartmental resection performed; preoperative imaging, including assessment of posterior deep spaces and the infratemporal fossa (ITF), informed template selection. Results: ITF infiltration was absent in 38.2% of cases, partial in 35.3%, and extensive in 26.5%. Resection types were CCMR type 1 in 32.4%, type 2 in 38.2%, and type 3 in 29.4%. Negative margins were achieved in 79.4%; posterior and medial margin control remained reliable even with partial or extensive ITF involvement. Median follow-up was 21 months. Local control rates at one and three years were 81.9% and 75.1%, respectively. Conclusion: CCMR appears to be a feasible and anatomically standardized surgical strategy for selected maxillary cancers arising from the oral cavity or maxillary sinus with deep craniofacial extension. By integrating compartmental resection principles with combined endoscopic–open approaches, this technique may support margin-oriented surgical planning and reliable control of deep posterior and medial margins, including in cases with ITF involvement. Further studies with longer follow-up are needed to define its oncologic impact.