title: Surgical palatomaxilloschisis: an avenue to the pterygomaxillary space.
abstract: The pterygomaxillary space (PMS) is a potential reservoir for expansion of the neoplasms originating in the epipharynx. Palatotomic and mandibulotomic approaches to this secluded site have been reported. The advantages of surgical palatomaxilloschisis are twofold. First, the exposure of the operative field is panoramic. Second, the carotid arterial system is identifiable prior to surgical intervention. The triangular pterygomaxillary recess is bounded superiorly by the greater wing of the sphenoid, posteriorly by the pterygoid process and anteriorly by the dorsal convexity of the posterior wall of the maxilla. Ascending laterally to the PMS in its route to penetrate the temporal bone is the internal carotid artery. In particular, juvenile angiofibromas which originate in the epipharynx may in their growth encroach upon the bounds of the PMS. The surgical objective is not only to extirpate the neoplasm but also to safeguard the carotid arterial system which may be displaced by the new growth and thereby become a surgical hazard. A clinical experience illustrates the applicability of this approach.
mesh_terms: D000293:Adolescent; D018219:Histiocytoma, Benign Fibrous / Q000601:surgery*; D006801:Humans; D008443:Maxillary Sinus / Q000601:surgery; D008722:Methods; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery