Uninostril versus Binostril Endoscopic Transnasal Approach for Pterygopalatine Fossa: A Technical Note

Background: Endoscopic transnasal approach is considered good access to the pterygopalatine fossa and has been described to approach multiple paramedian skull base pathologies.

Objectives: To evaluate the difference in the surgical exposure and lateral extension of the endoscopic transnasal approach to the pterygopalatine fossa using the uninostril versus binostril technique.

Methods: The uninostril and binostril endoscopic transnasal approaches were orderly performed on fresh injected cadaveric head to quantitatively assess surgical freedom and attack angle for pterygopalatine fossa. A neuronavigation system was used to obtain the measurements.

Results: The uninostril endoscopic transnasal approach allowed an adequate exposure for the vidian nerve, pterygopalatine ganglion, and localization of the maxillary nerve with limited surgical flexibility and less angular attack in the coronal plan. The binostril endoscopic transnasal approach provided greater surgical flexibility at the pterygopalatine fossa, with a wider angular attack. The binostril technique added a 6-mm lateral extension in the coronal plan. For the angle of attack, the uninostril technique offered a 24-mm lateral extension from the nasal septum compared with 30 mm for the binostril technique using a zero scoop and straight instrument.

Conclusion: The uninostril technique is an excellent technique for vidian nerve decompression, it is a direct, less time-consuming, and less destructive approach. While the binostril technique is recommended for lesion surgery where more surgical freedom and wider attach of angle are required ([Figs. 1] [2] [3] [4]).

Publication History

Article published online:
01 February 2023