title: Endoscopic approach to the infratemporal fossa for treatment of invasive fungal sinusitis.
abstract: BACKGROUND
  Invasive fungal sinusitis is a progressive disease that can often extend beyond the nasal cavities and paranasal sinuses into surrounding soft tissue and bone. Aggressive antifungal therapy and surgical debridement are the mainstays of management. The pterygopalatine fossa and infratemporal fossa are two regions that are commonly involved in patients with invasive fungal sinusitis. When fungal disease extends to the infratemporal fossa, surgical debridement can be challenging. Traditionally, open approaches have been used for the management of disease in these areas. Advances in endoscopic skull base surgery may allow for less invasive approaches for the management of disease in the infratemporal fossa. This article describes a transnasal endoscopic approach to the infratemporal fossa for debridement of invasive fungal sinusitis.
  
  
  METHODS
  Patients with invasive fungal sinusitis extending into the infratemporal fossa were treated with endoscopic debridement. Records of these patients were reviewed.
  
  
  RESULTS
  Endoscopic debridement was performed in four patients with infratemporal fossa extension of invasive fungal sinusitis. Responsible organisms included Aspergillus, Mucor, and Candida. Adequate access and excellent visualization of the infratemporal fossa were obtained in all patients. The endoscopic anatomy and surgical technique are presented.
  
  
  CONCLUSIONS
  Endoscopic approaches have been used to manage a variety of disease processes that extend beyond the confines of the paranasal sinuses. Invasive fungal sinusitis disease with extension into the infratemporal fossa can be safely debrided via a transnasal endoscopic technique. The approach provides excellent visualization with low morbidity.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, State University of New York Upstate Medical University, Syracuse, New York, USA. goyalp@upstate.edu
authors.forename: Parul
authors.initials: P
authors.lastname: Goyal
authors.forename: Man-Kit
authors.initials: MK
authors.lastname: Leung
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hwang
mesh_terms: D000368:Aged; D001230:Aspergillus / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D003646:Debridement / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D008875:Middle Aged; D009089:Mucor / Q000302:isolation & purification; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D009666:Nose; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome