title: Graduated endoscopic multiangle approach for access to the infratemporal fossa: a cadaveric study with clinical correlates.
abstract: OBJECTIVE
  The infratemporal fossa (ITF) has historically been one of the most difficult regions of the skull base to access surgically. Available open approaches are complex, are associated with high morbidity, and do not always afford optimal visualization. Endoscopic access to the ITF improves visualization for management of many sinonasal and lateral skull base lesions involving this region. The purpose of this study is to evaluate a graduated multiangle approach for endoscopic access to this area using a cadaveric model.
  
  
  METHODS
  Cadaveric study at an academic medical center.
  
  
  METHODS
  Endoscopic dissection was performed on a total of 10 sides of 5 fresh cadaveric heads. Four different approaches to the ITF were studied: ipsilateral endonasal, endoscopically assisted Caldwell-Luc, contralateral endonasal via septotomy, and endoscopically assisted Gillies transtemporal. High-quality endoscopic pictures and high-definition videos of each technique were obtained in order to document the differences in access achieved with each approach.
  
  
  RESULTS
  The combination of the 4 different endoscopic techniques allowed complete access to all areas of the ITF. The endoscopically assisted Caldwell-Luc improved anteroposterior access, the contralateral septotomy approach resulted in excellent far lateral access, and the endoscopically assisted Gillies approach allowed posterosuperior visualization and instrumentation.
  
  
  CONCLUSIONS
  Endoscopic access to the ITF can be accomplished by each of the 4 methods described. A multiangle, graduated approach can provide surgeons the ability to customize surgical access depending on the location of a specific lesion within the ITF.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07103, USA. jean.anderson.eloy@gmail.com
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Kim P
authors.initials: KP
authors.lastname: Murray
authors.forename: Mark E
authors.initials: ME
authors.lastname: Friedel
authors.forename: Belachew
authors.initials: B
authors.lastname: Tessema
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery*