J Neurol Surg B Skull Base 2021; 82(04): 437-442
DOI: 10.1055/s-0040-1713106
Original Article

Advanced Endoscopic Endonasal Approach to the Pterygopalatine Fossa and Orbit: The Endoscopic Tri-port Approach

Kazuhiro Omura
1   Department of Otolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
2   Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
,
Kazuhiro Nomura
3   Department of Otolaryngology, Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
,
Ryosuke Mori
4   Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
,
Yudo Ishii
4   Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
,
Yasuhiro Tanaka
2   Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
,
Nobuyoshi Otori
1   Department of Otolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
,
Hiromi Kojima
1   Department of Otolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
› Author Affiliations

Abstract

Objective The pterygopalatine fossa (PPF) is a narrow space situated posterior to the maxillary sinus. While external approaches have been used to treat tumors of the PPF, recent endoscopic approaches have become favored as an alternative; we developed an endoscopic tri-port approach, which provides wide surgical corridor with minimal invasion, for PPF. This report aims to introduce and verify the new approach.

Design Case series.

Setting A tertiary referral hospital.

Participants We reviewed 11 patients with PPF or orbital tumors who were treated with the endoscopic tri-port approach.

Main Outcome Measures Accessing tri-port approach's effects and limitations.

Results When the tumor was located in the PPF or orbit without intracranial invasion, en bloc resection was achieved in six patients. With the exception of one patient, the nasal septum was preserved if not used for skull base reconstruction. If not invaded by a tumor or necessary for reconstruction, the inferior and middle turbinates were preserved.

Conclusion The endoscopic tri-port approach provides an excellent surgical view and wide corridor and not requires an external approach, including a gingival incision.



Publication History

Received: 08 November 2019

Accepted: 26 April 2020

Article published online:
19 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Alfieri A, Jho HD, Schettino R, Tschabitscher M. Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study. Neurosurgery 2003; 52 (02) 374-378
  • 2 DelGaudio JM. Endoscopic transnasal approach to the pterygopalatine fossa. Arch Otolaryngol Head Neck Surg 2003; 129 (04) 441-446
  • 3 Solari D, Magro F, Cappabianca P. et al. Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks. J Neurosurg 2007; 106 (01) 157-163
  • 4 Battaglia P, Turri-Zanoni M, Lepera D. et al. Endoscopic transnasal approaches to pterygopalatine fossa tumors. Head Neck 2016; 38 (Suppl. 01) E214-E220
  • 5 Plzák J, Kratochvil V, Kešner A, Šurda P, Vlasák A, Zvěřina E. Endoscopic endonasal approach for mass resection of the pterygopalatine fossa. Clinics (São Paulo) 2017; 72 (09) 554-561
  • 6 Leong SC, Macewen CJ, White PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy 2010; 24 (01) 81-90
  • 7 Liu JK, Husain Q, Kanumuri V, Khan MN, Mendelson ZS, Eloy JA. Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach. J Neurosurg 2016; 124 (05) 1328-1338
  • 8 Omura K, Asaka D, Nayak JV, Tanaka Y. Transseptal access with crossing multiple incisions for improved pedicle control and septum preservation: “How I do it”. Am J Rhinol Allergy 2017; 31 (02) 139-141
  • 9 Omura K, Nomura K, Aoki S, Katori Y, Tanaka Y, Otori N. Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures. Int Forum Allergy Rhinol 2018; DOI: 10.1002/alr.22122.
  • 10 Nakayama T, Asaka D, Okushi T, Yoshikawa M, Moriyama H, Otori N. Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct. Am J Rhinol Allergy 2012; 26 (05) 405-408
  • 11 Weber RK, Werner JA, Hildenbrand T. Endonasal endoscopic medial maxillectomy with preservation of the inferior turbinate. Am J Rhinol Allergy 2010; 24 (06) 132-135
  • 12 Omura K, Nomura K, Aoki S, Otori N, Tanaka Y. Direct approach to the anterior and lateral part of the maxillary sinus with an endoscope. Auris Nasus Larynx 2019; 46 (06) 871-875
  • 13 Bailie N, Hanna B, Watterson J, Gallagher G. A model of airflow in the nasal cavities: Implications for nasal air conditioning and epistaxis. Am J Rhinol Allergy 2009; 23 (03) 244-249
  • 14 Leong SC, Chen XB, Lee HP, Wang DY. A review of the implications of computational fluid dynamic studies on nasal airflow and physiology. Rhinology 2010; 48 (02) 139-145
  • 15 Alimohamadi M, Hajiabadi M, Gerganov V, Fahlbusch R, Samii M. Combined endonasal and sublabial endoscopic transmaxillary approach to the pterygopalatine fossa and orbital apex. Acta Neurochir (Wien) 2015; 157 (06) 919-929
  • 16 Daniel RK, Palhazi P. The nasal ligaments and tip support in rhinoplasty: an anatomical study. Aesthet Surg J 2018; 38 (04) 357-368