Semin Plast Surg 2020; 34(02): 099-105
DOI: 10.1055/s-0040-1709432
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transpalatal Approaches to the Skull Base and Reconstruction: Indications, Technique, and Associated Morbidity

Nyall R. London Jr.
1  Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio
2  Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
3  Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland
,
Jimmy Y. W. Chan
4  Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, People's Republic of China
,
Ricardo L. Carrau
1  Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio
5  Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
06 May 2020 (online)

Abstract

Multiple anterior surgical approaches are available to obtain access to the nasopharynx, clivus, and craniocervical junction. These include the direct and transoral robotic surgery transpalatal, maxillary swing, and endoscopic endonasal approaches. In this article, we describe the indications for these techniques, surgical steps, and associated morbidities. This article is a PubMed literature review. A review of the literature was conducted to assess the techniques, surgical steps, and associated morbidities with transpalatal approaches to the skull base and nasopharynx. The transpalatal approach has been traditionally utilized to obtain surgical access to the nasopharynx, clivus, and craniocervical junction. Morbidity includes velopalatine insufficiency due to shortening of the soft palate from scar contraction or neuromuscular damage, thus leading to hypernasal speech and dysphagia. Middle ear effusion and oronasal or oronasopharyngeal palatal fistula are additional potential morbidities. The choice of surgical approach depends on a variety of factors including the disease location and extent, surgeon experience, and available resources.