Surgical resection of a cutaneous squamous cell carcinoma invading the infraorbital maxillary nerve

Surgical resection of cutaneous squamous cell carcinomas with perineural tumor invasion (SCC) represents an oncological challenge. Although perineural tumor invasion occurs in about 3% of all SCC of the skin, it is recognized as a poor prognostic factor and intracranial spread can occur through cranial nerve pathways. We describe in a stepwise fashion our combined approach for a complete resection of the infraorbital maxillary nerve from its skin terminations all the way up to its intracranial portion. The surgery consisted in an orbitozygomatic translocation and a pterional craniectomy, exposure of the intra and extracranial maxillary nerve, an en bloc resection of the affected infraorbital branch of the maxillary nerve from the skin up to its pre-cavernous segment, orbital floor bone removal. Patient then underwent reconstruction of the floor and the lateral wall of the orbit with excellent cosmetic results. Due to its rarity, to our knowledge this is the first technical note in the English literature presenting a complete illustrated description of surgical technique for complete oncological resection these type of skin cancers.