Modified endoscopic transnasal‐transmaxillary‐transpterygoid approach to parapharyngeal space tumor resection

Wasano, Koichiro; Yamamoto, Sayuri; Tomisato, Shuta; Kawasaki, Taiji; Ogawa, Kaoru

doi:10.1002/hed.24399

Cited by 18 publications

(10 citation statements)

References 7 publications

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“…8,10,15,18 Meanwhile, with the evolution of endoscopic skull base surgery, the transnasal approach has also been adopted to manage lesions in the PPS. 9,11 The endoscopic transnasal TP approach can provide a direct route to the upper PPS, but it has also some drawbacks, such as a long and narrow surgical corridor, constricted lateral exposure, limited inferior access, and Eustachian tube resection when extended surgical exposure is needed. 13 The trajectory of the endoscopic transnasal TP approach to the upper PPS is restricted laterally by the medial and lateral pterygoid muscles.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, endoscope-assisted TO (with or without surgical robotic system) and transnasal transpterygoid (TP) approaches have been used to remove benign lesions of the PPS with reduced surgical complications and cosmetic deformity relative to traditional external approaches. [8][9][10][11] Because of anatomical complexity with important neurovascular structures in the PPS, minimally invasive approaches to this region require detailed and precise anatomic knowledge. Although many operative procedures and endoscopic anatomy of the PPS have been reported, the target area in these investigations is only focused on upper or lower PPS.…”

Section: Introductionmentioning

confidence: 99%

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A Comparative Analysis of Endoscopic-Assisted Transoral and Transnasal Approaches to Parapharyngeal Space: A Cadaveric Study

et al. 2017

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Surgical resection of parapharyngeal space (PPS) tumors is very challenging. An endoscopic-assisted surgical approach to this region requires detailed and precise anatomic knowledge. The main purpose of this study is to describe and compare the detailed anatomy of the PPS via transnasal transpterygoid (TP) and endoscopic-assisted transoral (TO) approaches. Six fresh injected cadaver heads (12 sides) were prepared for dissection of the PPS via TP and TO approaches. Computed tomography (CT) with image-based navigation (Navigation System II; Stryker, Kalamazoo, Michigan, United States) was used to identify bony structures around the PPS. TP and TO approaches could both expose the detailed anatomical structures in the PPS. The TP approach can provide a direct route to the upper PPS, but it is limited inferiorly by the hard palate and laterally by the medial and lateral pterygoid muscles. However, the TO approach can provide a direct route to the lower PPS, but it is difficult to expose the area around the Eustachian tube. The styloglossus and stylopharyngeus muscles could be considered as the safe anterior boundary of the parapharyngeal internal carotid artery (ICA) with the TO approach. Dissection between the stylopharyngeus muscle and the superior pharyngeal constrictor muscle provides direct access to the parapharyngeal ICA. The TP and TO approaches provide new strategies to manage lesions in the PPS. The important neurovascular structures of the PPS could be identified with these approaches. The endoscopic-assisted TO approach can provide direct access to the parapharyngeal ICA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Comparative Analysis of Endoscopic-Assisted Transoral and Transnasal Approaches to Parapharyngeal Space: A Cadaveric Study

et al. 2017

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“…Transnasal endoscopic access by means of a transpterygoid approach allows access to the upper part of the PPS . Wasano et al have described the modified endoscopic transnasal‐transmaxillary‐transpterygoid approach, in which the surgical corridor to the PPS consists of the maxillary sinus, submucous tunnel under the lateral nasal wall, and the space created by removing the pterygoid process. This deep region has traditionally been approached through open lateral or anterior approaches, which are associated with several significant complications .…”

Section: Surgerymentioning

confidence: 99%

Contemporary management of primary parapharyngeal space tumors

et al. 2018

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The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.

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“…Traditionally, tumors arising from the PPS have been managed through a variety of lateral approaches, including transcervical, transoral, mandibular swing, transparotid, transmastoid, and infratemporal fossa (ITF) approaches and their combinations [4,5]. Increasing literatures have presented the application of endoscopic endonasal surgery in managing lesions involving the upper PPS, with the advantage of reducing the incidence of functional and cosmetic morbidity related to open approaches [6,7]. Van Rompaey et al demonstrated that an endoscopic transmaxillary/transpterygoid approach provided a sufficient surgical window for tumor extirpation, obviating some of the morbidity associated with an open procedure; however, this approach was limited by its access to the petrous portion of the internal carotid artery (ICA) [2].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic transnasal transmaxillary approach to the upper parapharyngeal space and the skull base

Liu

Wang

Zhang

et al. 2019

Eur Arch Otorhinolaryngol

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Purpose Treatment of tumors arising in the upper parapharyngeal space (PPS) or the floor of the middle cranial fossa is challenging. This study aims to present anatomical landmarks for a combined endoscopic transnasal and anterior transmaxillary approach to the upper PPS and the floor of the middle cranial fossa and to further evaluate their clinical application. Methods Dissection of the upper PPS using a combined endoscopic endonasal transpterygoid and anterior transmaxillary approach was performed in six cadaveric heads. Surgical landmarks associated with the approach were defined. The defined approach was applied in patients with tumors involving the upper PPS. Results The medial pterygoid muscle, tensor veli palatini muscle and levator veli palatini muscle were key landmarks of the approach into the upper PPS. The lateral pterygoid plate, foramen ovale and mandibular nerve were important anatomical landmarks for exposing the parapharyngeal segment of the internal carotid artery through a combined endoscopic transnasal and anterior transmaxillary approach. The combined approach provided a better view of the upper PPS and middle skull base, allowing for effective bimanual techniques and bleeding control. Application of the anterior transmaxillary approach also provided a better view of the inferior limits of the upper PPS and facilitated control of the internal carotid artery. Conclusions Improving the knowledge of the endoscopic anatomy of the upper PPS allowed us to achieve an optimal approach to tumors arising in the upper PPS. The combined endoscopic transnasal and anterior transmaxillary approach is a minimally invasive alternative approach to the upper PPS.

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Modified endoscopic transnasal‐transmaxillary‐transpterygoid approach to parapharyngeal space tumor resection

Abstract: The MENMAP approach is a viable alternative for removing parapharyngeal space tumors, as it is safe, feasible, and less invasive. © 2016 Wiley Periodicals, Inc. Head Neck 38: 933-938, 2016.

Cited by 18 publications

References 7 publications

A Comparative Analysis of Endoscopic-Assisted Transoral and Transnasal Approaches to Parapharyngeal Space: A Cadaveric Study

A Comparative Analysis of Endoscopic-Assisted Transoral and Transnasal Approaches to Parapharyngeal Space: A Cadaveric Study

Contemporary management of primary parapharyngeal space tumors

Endoscopic transnasal transmaxillary approach to the upper parapharyngeal space and the skull base

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