Endoscopic approach to the infratemporal fossa: anatomic study.
OBJECTIVE
Classic surgical exposures of the infratemporal fossa region, including the adjacent intracranial space, temporal bone, and sinonasal region, require the extensive exposure associated with the transcranial, transfacial, and transmandibular approaches with their inherent neurological and cosmetic morbidities. In this study, we evaluated the feasibility and exposure afforded by combining 2 endoscopic transmaxillary approaches, endonasal and Caldwell-Luc supplement, to the infratemporal fossa.


METHODS
Endoscopic transmaxillary dissection was performed in 4 formalin-fixed cadaver heads (8 sides). We quantified the extent of exposure achieved within the pterygopalatine and infratemporal fossae after our initial dissection, which was endonasal with a medial antrostomy, and after addition of a Caldwell-Luc incision with an anterior antrostomy. Complementing this anatomic study, we report on a patient in whom this endoscopic transmaxillary approach combining the endonasal and Caldwell-Luc approaches was used for resection of a trigeminal schwannoma in the infratemporal fossa.


RESULTS
The combination of these 2 endoscopic transmaxillary approaches enabled visualization of the entire region of the pterygopalatine fossa and anteromedial aspect of the infratemporal fossa. Additional posterolateral exposure of the infratemporal fossa requires significant traumatic traction on the nose. Addition of the Caldwell-Luc transmaxillary approach exposed the remainder of the infratemporal fossa, including the mandibular nerve and branches, middle meningeal artery, and even the distal cervical portion of the internal carotid artery.


CONCLUSIONS
Endoscopic exposure of the infratemporal fossa is feasible. Using the combination of the endonasal and Caldwell-Luc approaches for direct transmaxillary access significantly extended exposure, allowing safe and effective resection of infratemporal fossa lesions.
Theodosopoulos
Philip V
PV
Department of Neurosurgery, University of Cincinnati, College of Medicine, PO Box 670515, Cincinnati, OH 45267-0515, USA. editor@mayfieldclinic.com
Guthikonda
Bharat
B
Brescia
Aaron
A
Keller
Jeffrey T
JT
Zimmer
Lee A
LA
D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery; D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006261:Headache / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009296:Nasal Cavity / Q000601:surgery; D009442:Neurilemmoma / Q000150:complications / Q000601:surgery; D056739:Pterygopalatine Fossa / Q000033:anatomy & histology / Q000601:surgery; D013701:Temporal Bone / Q000033:anatomy & histology* / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery