Quantitative evaluation of transtemporal and facial translocation approaches to infratemporal fossa.
OBJECTIVE
To compare the extent of exposure and surgical maneuverability provided by facial translocation and transtemporal approaches for access to the infratemporal fossa and anterolateral skull base.


METHODS
Surgical procedures were performed on five fresh frozen adult cadavers (ten sides) with no known pathology. Facial transfacial approaches with and without a mandibulotomy and transtemporal approaches were evaluated. OBJECTIVE measures were (1) the distance from the surgical plane to designated anatomic landmarks and (2) the surgical angle of exposure.


RESULTS
Distances from the surgical plane to the anatomic reference points were comparable for most of the access procedures (3 to 6 cm). The extended midfacial translocation and bilateral facial translocation approaches did, however, provide a shorter operative distance (1 to 3 cm) for access to the infratemporal fossa and contralateral structures, respectively. The transtemporal approaches facilitate a better angle of exposure (74 to 84 degrees) to the petrotemporal region, while the transfacial approaches were superior for access to the infratemporal structures.


CONCLUSIONS
Based on the results, we propose a clinical algorithm for selecting a surgical approach based on the position and extent of an infratemporal or petrotemporal lesion.
Kuriakose
Moni A
MA
Head and Neck Institute, Amrita Institute of Medical Sciences, Kerala, India.
Sorin
Alex
A
Sharan
Rajeev
R
Fishman
Andrew J
AJ
Babu
Ramesh
R
Delacure
Mark D
MD