title: Endoscopic anterior maxillotomy: infratemporal fossa via transnasal approach.
abstract: OBJECTIVE
  To evaluate our initial experience with a novel technique, endoscopic anterior maxillotomy (EAM), for improved access to the anterior-lateral skull base. Clinical and radioanatomic data are presented to describe and define this novel technique.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Surgical patients with lesions of the pterygopalatine fossa, infratemporal fossa, and anterior-lateral maxilla treated from 2006 to 2008 are reviewed. Demographic data and surgical technique are presented. A radioanatomic analysis pre- and post-EAM is performed to describe increased access. Matched-paired analysis was performed for statistical evaluation.
  
  
  RESULTS
  Thirty-two patients had surgical treatment of anterior-lateral skull base lesions. EAM was utilized in 16 cases. Fifty-six percent extended lateral to V2 and 56% extended posterior to the maxillary sinus. Complete resection was achieved in 11 patients. There was one unplanned subtotal resection. Radioanatomic measurements demonstrated an increase in the radius of surgical access to the ipsilateral skull base using the EAM when compared with both standard transnasal techniques (33.1° vs. 14.8°; P < .0001) and extended approaches removing the nasolacrimal duct (33.1° vs. 23.5°; P < .001). Similar findings were noted for lateral access to the contralateral skull base.
  
  
  CONCLUSIONS
  Endoscopic anterior maxillotomy is a novel technical addition to the skull base surgeon's armamentarium. Radioanatomic analysis demonstrates a significant improvement in access to the anterolateral skull base.
authors: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA. ielsayed@ohns.ucsf.edu
authors: Ivan
authors: I
authors: El-Sayed
authors: Steve
authors: S
authors: Pletcher
authors: Matthew
authors: M
authors: Russell
authors: Michael
authors: M
authors: McDermott
authors: Andrew
authors: A
authors: Parsa
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D035262:Cranial Fossa, Anterior / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed