Transcoronoid Maxillectomy Approach: A Cadaveric Study

Background: Maxillectomies are approaches to address pathology of the midface. Conservative maxillectomy allows preservation of orbital, alveolar, palate, and zygomatic bone. Intraoperative and postoperative complications are directly related to surgical techniques. The traditional maxillectomy technique does not allow for direct visualization of the infratemporal fossa (ITF); however, removal of the coronoid process of the mandible considerably enhances visibility to the complex anatomy located within the ITF with minimal morbidity.

Objective: The aim of this cadaveric study is to compare between the exposure afforded by a traditional infrastructure maxillectomy and a novel transcoronoid approach. Measurements were performed in cadaveric dissections to highlight the exposure of the approach.

Materials and Methods: Five fresh cadaveric heads were used for dissection and 10 approaches were performed for anatomic consideration. Dissection for the traditional and transcoronoid approaches were performed using a standard open technique. Comparative measurements were performed using the sigmoid notch, coronoid process, and junction of the zygomatic arch with the maxilla as reference points. Measurements and photographs were taken pre- and postresection of the coronoid process to assess improved visualization of the ITF. Three independent observers performed the measurements separately and the results were averaged.

Results: Resecting the coronoid process increased the depth of visualization to the infratemporal fossa by an average of 23.9 mm ± 2.12 mm. The surface area of exposure increased on average from 17.5 to 51.2 mm². Resecting the coronoid process increased the surface area by 33.6 mm² (190%). With the transcoronoid approach, all 10 dissections (100%) allowed for direct visualization of the pterygoid plates and musculature, the internal maxillary artery and the mandibular branch of the trigeminal nerve that were not able to be previously visualized prior to resection of the coronoid process.

Conclusion: A transcoronoid maxillectomy approach increases visualization of the infratemporal fossa. Removing the coronoid process allows us to deliver more controlled osteotomies and to identify and control the internal maxillary artery in surgery of the maxilla. It allows for an increased surface area of dissection and for direct visualization of critical neurovascular structures in the ITF.

No conflict of interest has been declared by the author(s).