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.