Endoscopic Endonasal Approach to the Pterygopalatine Fossa and Infratemporal Fossa: Comparison of the Prelacrimal and Denker’s Corridors

Abstract

Background Both the endoscopic transnasal Denker’s and prelacrimal approaches provide surgical access to the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Objectives This study compares the potential maximum exposure of the PPF and ITF and quantifies the difference in surgical freedom via endoscopic Denker’s and prelacrimal approaches. Methods Six cadaveric specimens (12 sides) were dissected using a prelacrimal approach on one side and an endoscopic Denker’s approach on the contralateral side. The contents of the PPF and ITF were sequentially exposed. Surgical freedom for each corridor was subsequently calculated. Results This study confirms that both the prelacrimal and Denker’s approaches provide adequate exposure of the PPF and ITF. The maximum exposure boundaries were similar for both approaches, including the middle cranial fossa superiorly, floor of the maxillary sinus inferiorly, zygomatic arch and temporomandibular joint laterally, and post-styloid space posteriorly. However, the data revealed a statistically significant difference ( p < 0.05) regarding the surgical freedom of the prelacrimal (388.17 ± 32.86 mm2) and the endoscopic Denker’s approaches (906.35 ± 38.38 mm2). Conclusion When compared with an endoscopic Denker’s approach, a prelacrimal approach seems to achieve a similar extent of exposure (ie, visualization) of the PPF and ITF. Nonetheless, the endoscopic Denker’s approach offers superior surgical freedom; thus, it is preferred for the management of complex lesions which requires increased instrument maneuverability with a 3- or 4-handed technique.

Transorbital Endoscopic Approach to the Foramen Rotundum for Infraorbital Nerve Stripping

“…Indeed, the transnasal prelacrimal approach or endoscopic Denker’s approach are 2 techniques that provide ample exposure of the PPF and infratemporal fossa, with “surgical freedom” defined as the maximal region of surgical maneuverability to be 388.17 ± 32.86 mm 2 , and 906.35 ± 38.38 mm 2 , respectively. 30 The transorbital approach is unlikely to provide this amount of surgical freedom. However, it is a reproducible technique for stripping the ION branch and maxillary nerve from the infraorbital foramen back to the FR, which is particularly pertinent in pathologies with PNS.…”

Infra-Temporal and Pterygo-Palatine Fossae Tumors: A Frontier in Endoscopic Endonasal Surgery—Description of the Surgical Anatomy of the Approach and Report of Illustrative Cases

“…Moreover, we have recently started to avoid completely cutting the inferior nasal concha, preferring a partial resection, followed by re-suturing at the end of the surgery, furtherly reducing the post-operative nasal discomfort. Moreover, the anteromedial maxillectomy has demonstrated greater surgical freedom and consequently increased instrument maneuverability in comparison also to prelacrimal approaches [ 60 ].…”

Endoscopic endonasal transpterygoid nasopharyngectomy: Anatomical considerations and technical note

“…This study contributes insights into this specialized field and serves as a complement to the comprehensive body of work dedicated to other areas of surgical exposure. In instances where the tumor involves the pterygoid space, infratemporal fossa, as well as the deep parapharyngeal space, other combined approaches 35,38,41,42 will be undertaken to achieve tumor removal.…”