Endoscopic versus Open Approach to the Infratemporal Fossa

Introduction: Various lateral and anterior approaches have been described to access the infratemporal fossa. Compared with lateral approaches to the infratemporal fossa, the endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure of midline structures such as the paranasal sinuses, nasopharynx, Eustachian tube, sella, and clivus.Through this study we want to compare the endoscopic transpterygoid approach to the preauricular subtemporal approach to the infratemporal fossa to listing their respective advantages and drawbacks through a cadaveric dissection and clinical correlation.

Methods: A cadaveric study was performed on five adult specimens. Endoscopic transpterygoid approach to infratemporal fossa was done in three cadavers and open preauricular infratemporal fossa was done bilaterally in two heads. Also a clinical retrospective study was completed for all the patients who were surgically treated using either the endoscopic endonasal approach or open preauricular subtemporal approach to manage lesions in infratemporal fossa.

Results: A total of ten infratemporal and pterygopalatine fossae (five cadaveric specimens) were dissected either endoscopically or using the open approach to study the critical differences between both approaches.The clinical study was performed to list the different indications and limitations of each approach.

Conclusions: Endscopic transpterygoid approach becomes the standard surgical solution for most of benign and some malignant tumors that involve the infratemporal fossa and middle cranial fossa. Open approaches play an important role, especially in resection of large malignant tumors of maxilla and mandible, in terms of combination with other craniofacial approaches for tumors resection.

• ITF (infratemporal fossa)

• PPF (pterygopalatine fossa)

• LPM (lateral pterygoid muscle)

• ICA (internal carotid artery)

• IMA (internal maxillary artery)

• TMJ (tempromandibular joint)

• ALT (anterolateral thigh).

Keywords:

infratemporal fossa - transpterygoid approach - preauricular subtemporal approach - V2 - V3.