Abstract
The anteromedial temporal region and the lateral wall of the sphenoid can be the site
of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol
granuloma of the petrous apex, malignancy, infection, and sellar pathology extending
to the lateral cavernous sinus. Approaches to this region are technically challenging
and the existing approach requires sacrifice of all of the turbinates including the
nasolacrimal duct, which can cause postoperative complications.
We describe a novel anatomical landmark between the periorbita and the periosteum
of the pterygopalatine fossa (which is located at the inferolateral periorbital periosteal
line [ILPPL]). The posterior one-third of the incision line lies between the foramen
rotundum and the superior orbital fissure, which is proximal to the maxillary strut.
A 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the
posterior inferolateral orbital region, anteromedial temporal region, lateral wall
of the sphenoid sinus, and lateral wall of the cavernous sinus.
A combined multiangled approach to the ILPPL will enable us to preserve all of the
turbinates and the septum, and the nasolacrimal duct, allowing for the preservation
of the physiological function and pedicled flaps, such as the middle turbinate, inferior
turbinate, and septal membrane flap.
The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach
to the anteromedial temporal fossa.
Keywords skull base - sinus cancer - cranial base - endoscopic sinus surgery - endoscopic skull
base surgery
