Endoscopic Approach to the Infratemporal Fossa

Abstract

Endoscopic exposure of the infratemporal fossa is feasible. Using the combination of the endonasal and Caldwell-Luc approaches for direct transmaxillary access significantly extended exposure, allowing safe and effective resection of infratemporal fossa lesions.

Comparison of Surgical Freedom and Area of Exposure in Three Endoscopic Transmaxillary Approaches to the Anterolateral Cranial Base

“…Several transmaxillary approaches have been used in the treatment of retromaxillary lesions. 9,14 Our data show that the sublabial approach provides the best horizontal working space, and the endonasal approach has the least horizontal working space; therefore, a sublabial approach may be superior in the case of tumors that extend in the same axial plane. In addition, we found that the transseptal approach has the least vertical working space; as a result, it may not be the best option in the case of tumors or lesions that extend in the same sagittal plane.…”

“…In addition, we found that the transseptal approach has the least vertical working space; as a result, it may not be the best option in the case of tumors or lesions that extend in the same sagittal plane. The approaches we describe in this study were previously described with a detailed anatomical overview, 9,19 but an analysis of the exposed working space, including the surgical freedom and the area of exposure, has not been previously described. These concepts are important in planning the appropriate surgical approach for a specific lesion and for understanding the limitations of each of the approaches.…”

“…maxillary sinus have gradually replaced traditional open approaches for certain anterior and anterolateral skull base lesions. [4][5][6][7][8][9][10] The armamentarium of endoscopic approaches to this region includes the ipsilateral endonasal transmaxillary approach, sublabial transmaxillary approach (Caldwell-Luc), and the contralateral transseptal transmaxillary approach. 8 The anterolateral skull base is anatomically complex and has been well described.…”

“…8 The anterolateral skull base is anatomically complex and has been well described. 9,11,12 The infratemporal fossa and the pterygopalatine fossa communicate through the pterygomaxillary fissure. They are connected with the orbit through the inferior orbital fissure and with the middle cranial fossa through the foramen spinosum, foramen ovale, and foramen rotundum.…”

“…A transmaxillary corridor has been used to access the infratemporal fossa, parapharyngeal space, middle cranial fossa, and anterolateral skull base. 6,7,9 However, detailed anatomical comparisons of endoscopic approaches with anatomical correlations in these areas are lacking but are necessary for selecting the optimal approach.…”