Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa

Abstract

Objective: To demonstrate anatomic relationships pertinent to the endoscopic multiport approach to the infratemporal fossa (ITF). Discuss advantages and limitations of each individual approach.Study Design: Cadaveric study.Methods: Endoscopic and endoscopic-assisted endonasal transpterygoid, sublabial transmaxillary, endoscopic transorbital, and endoscopic transoral approaches to accessing the ITF were completed in five silicone-injected fresh cadaveric specimens (10 sides) with the assistance of 0, 30, and 45 0 rods-lens endoscopes. Image guidance was used to confirm and document the anatomical relationships encountered in each approach.Results: The endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure to median structures. Endoscopic-assisted sublabial transmaxillary approach enhances the field of exposure, angle of attack, and ease of instrumentation to the lateral part of the ITF. Endoscopic-assisted transorbital approach via the inferior orbital fissure provided cephalic and anterior access. Endoscopic-assisted transoral approach complements the access to lesions extending inferior to the hard palate or far lateral to the mandibular condyle.Conclusions: A combination of minimal access infratemporal approaches can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches.

Infratemporal Fossa Schwannoma Surgery via a Combined Prelacrimal Recess, Caldwell-Luc, and Distal Intraoral Approach

“…Nowadays, the utilization of certain modified open surgical approaches, such as the fronto-orbito-zygomatic approach 10 and the modified zygomatico-transmandibular approach, 11 has also yielded favorable surgical outcomes. However, with the advancement of endoscopic technology, an increasing number of endoscopic approaches been developed, including but not limited to: Caldwell-Luc approach, combined endonasal and Caldwell-Luc approach, 12 distal intraoral approach, 2 endoscopic transorbital approach, 13 prelacrimal recess approach, 14 and so forth. The selection of surgical approaches may vary depending on the extent of the lesion and invasion of surrounding structures, or a combination of multiple approaches can be considered 15 .…”

The Transorbital Approach: A Comprehensive Review of Targets, Surgical Techniques, and Multiportal Variants

“…Trans-pterygoid endonasal, trans-maxillary sublabial, transorbital endoscopic, and transoral endoscopic approaches to access the infratemporal fossa (ITF) were completed on five cadavers in another study. Indeed, the authors showed that a combination of infratemporal approaches with minimal access can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches [75]. However, nowadays the applicability of these approaches in clinical practice remains marginal, due to the nonetheless nonzero morbidities and associated technical challenges.…”