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J Neurol Surg B Skull Base 2022; 83(S 02): e514-e520
DOI: 10.1055/s-0041-1733919
Original Article

Endoscopic Paramaxillary Approach to the Infratemporal Fossa and Pterygomaxillary Space: Computer Modeling Analysis and Clinical Series

Neeraja Konuthula 
1   Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, Washington, United States
,
Waleed M. Abuzeid
1   Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, Washington, United States
,
Ian M. Humphreys
1   Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, Washington, United States
,
Randall A. Bly
1   Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, Washington, United States
2   Division of Pediatric Otolaryngology–Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, United States
,
Kris Moe
1   Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, Washington, United States
3   Otolaryngology–Head & Neck Surgery, Harborview Medical Center, Seattle, Washington, United States
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Abstract

Objective Several different open and endoscopic approaches for the pterygomaxillary space and infratemporal fossa have been described. Limitations to these approaches include restricted exposure of the infratemporal fossa and difficult surgical manipulation.

Study Design Consecutive clinical cases utilizing a novel approach to access lesions in the infratemporal fossa and pterygomaxillary space were reviewed. Data was collected on pathology, lesion location, and surgical approach(es) performed. Computer modeling was performed to analyze the full extent of surgical access provided by the paramaxillary approach to the range of target locations.

Results Ten consecutive cases met inclusion criteria. Surgical access to the target lesion was achieved in all cases. Computer modeling of the approach derived the anatomical boundaries of the paramaxillary approach. Wide access to the posterior maxilla, and lateral or medial to the mandibular condyle allows for variability in endoscopic angles and access to more medial pterygomaxillary space lesions. The lateral extent is limited proximally only by the extent of cheek/soft tissue retraction and by the zygomatic arch more superiorly. The superior limit of dissection is at the temporal line.

Conclusion The endoscopic paramaxillary approach is a transoral minimally disruptive approach to the ITF and PS that provides excellent surgical exposure for resection of lesions involving these areas. Compared with previously described endoscopic approaches, there are no external incisions; tumor manipulation is straightforward without angled endoscopy, and all areas of the infratemporal fossa and pterygomaxillary space can be accessed.

Keywords

pterygomaxillary - pterygopalatine - infratemporal fossa - computer modeling - paramaxillary - endoscopic approach


Publication History

Received: 09 March 2021

Accepted: 01 July 2021

Article published online:
18 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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