Endoscopic transnasal approach to the pterygopalatine fossa.
OBJECTIVE
To describe an endoscopic transnasal approach to the pterygopalatine fossa (PPF).


METHODS
Case series of 3 patients.


METHODS
An academic medical center. Patients One patient presented with an asymptomatic PPF schwannoma. The second patient presented after a sudden onset of complete unilateral vision loss with a complete ipsilateral sphenoid sinus opacification and radiographic signal abnormality in the PPF and inferior orbital fissure. The third patient had a history of adenoid cystic carcinoma of the lacrimal gland, and was found to have new-onset facial numbness. Intervention One patient had a complete excision of a schwannoma by means of an endoscopic transnasal approach. The other 2 patients had wide exposure and biopsies of the PPF. One patient had a revision procedure through the same approach with further lateral exposure to the area of the inferior orbital fissure.


RESULTS
All patients had successful endoscopic approaches for tumor removal (case 1) and biopsy (cases 2 and 3) of the PPF. The second patient had a repeat endoscopic biopsy 1 week later to obtain more tissue for diagnostic purposes. None of the patients had any major vascular complications. At follow-up, 2 of 3 patients had persistent sensory deficits.


CONCLUSIONS
The endoscopic transnasal approach to the PPF is a safe and effective method for biopsy and removal of PPF masses. The endoscopic approach improves access and visualization, and has the potential to reduce complications compared with open approaches. Image guidance is helpful in these cases.
DelGaudio
John M
JM
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA. john_delgaudio@emoryhealthcare.org
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D021362:Palate, Hard / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011626:Pterygoid Muscles / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed