Download PDF
J Neurol Surg B Skull Base 2016; 77(01): 066-074
DOI: 10.1055/s-0035-1564057
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae

Smita Upadhyay
1   Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Ricardo L. L. Dolci
1   Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Lamia Buohliqah
1   Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Mariano E. Fiore
2   Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Leo F.S. Ditzel Filho
2   Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Daniel M. Prevedello
1   Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
2   Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Bradley A. Otto
1   Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
2   Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Ricardo L. Carrau
1   Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
2   Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
› Author Affiliations
Further Information

Publication History

08 June 2015

13 July 2015

Publication Date:
09 September 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM).

Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target.

Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm2) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker.

Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.

Keywords

infratemporal fossa - endoscopic - medial maxillectomy - transseptal - endoscopic Denker - surgical freedom
 

  • References

  • 1 Cass SP, Hirsch BE, Stechison MT. Evolution and advances of the lateral surgical approaches to cranial base neoplasms. J Neurooncol 1994; 20 (3) 337-361
    CrossrefPubMedGoogle Scholar
  • 2 Fisch U. Infratemporal fossa approach for lesions in the temporal bone and base of the skull. Adv Otorhinolaryngol 1984; 34: 254-266
    PubMedGoogle Scholar
  • 3 Fisch U, Fagan P, Valavanis A. The infratemporal fossa approach for the lateral skull base. Otolaryngol Clin North Am 1984; 17 (3) 513-552
    Google Scholar
  • 4 Janecka IP. Classification of facial translocation approach to the skull base. Otolaryngol Head Neck Surg 1995; 112: 579-585
    PubMedGoogle Scholar
  • 5 Zhang M, Garvis W, Linder T, Fisch U. Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma. Laryngoscope 1998; 108 (11 Pt 1): 1717-1723
    CrossrefPubMedGoogle Scholar
  • 6 Theodosopoulos PV, Guthikonda B, Brescia A, Keller JT, Zimmer LA. Endoscopic approach to the infratemporal fossa: anatomic study. Neurosurgery 2010; 66 (1) 196-202 ; discussion 202–203
    CrossrefPubMedGoogle Scholar
  • 7 Harvey RJ, Sheehan PO, Debnath NI, Schlosser RJ. Transseptal approach for extended endoscopic resections of the maxilla and infratemporal fossa. Am J Rhinol Allergy 2009; 23 (4) 426-432
    CrossrefPubMedGoogle Scholar
  • 8 Wilson DA, Williamson RW, Preul MC, Little AS. Comparative analysis of surgical freedom and angle of attack of two minimal-access endoscopic transmaxillary approaches to the anterolateral skull base. World Neurosurg 2014; 82 (3–4) e487-e493
    Google Scholar
  • 9 Little AS, Nakaji P, Milligan J. Endoscopic endonasal transmaxillary approach and endoscopic sublabial transmaxillary approach: surgical decision-making and implications of the nasolacrimal duct. World Neurosurg 2013; 80 (5) 583-590
    CrossrefPubMedGoogle Scholar
  • 10 Prosser JD, Figueroa R, Carrau RI, Ong YK, Solares CA. Quantitative analysis of endoscopic endonasal approaches to the infratemporal fossa. Laryngoscope 2011; 121 (8) 1601-1605
    CrossrefPubMedGoogle Scholar
  • 11 Falcon RT, Rivera-Serrano CM, Miranda JF , et al. Endoscopic endonasal dissection of the infratemporal fossa: anatomic relationships and importance of eustachian tube in the endoscopic skull base surgery. Laryngoscope 2011; 121 (1) 31-41
    CrossrefPubMedGoogle Scholar
  • 12 Devaiah AK, Reiersen D, Hoagland T. Evaluating endoscopic and endoscopic-assisted access to the infratemporal fossa: a novel method for assessment and comparison of approaches. Laryngoscope 2013; 123 (7) 1575-1582
    CrossrefPubMedGoogle Scholar
  • 13 Elhadi AM, Almefty KK, Mendes GA , et al. Comparison of surgical freedom and area of exposure in three endoscopic transmaxillary approaches to the anterolateral cranial base. J Neurol Surg B Skull Base 2014; 75 (5) 346-353
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Figueiredo EG, Deshmukh V, Nakaji P , et al. An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 2006; 59 (4) (Suppl. 02) ONS212-ONS220 ; discussion ONS220
    Google Scholar
  • 15 Fahmy CE, Carrau R, Kirsch C , et al. Volumetric analysis of endoscopic and traditional surgical approaches to the infratemporal fossa. Laryngoscope 2014; 124 (5) 1090-1096
    CrossrefPubMedGoogle Scholar
  • 16 Goyal P, Leung MK, Hwang PH. Endoscopic approach to the infratemporal fossa for treatment of invasive fungal sinusitis. Am J Rhinol Allergy 2009; 23 (1) 100-104
    CrossrefPubMedGoogle Scholar
  • 17 Hosseini SM, Razfar A, Carrau RL , et al. Endonasal transpterygoid approach to the infratemporal fossa: correlation of endoscopic and multiplanar CT anatomy. Head Neck 2012; 34 (3) 313-320
    CrossrefPubMedGoogle Scholar
  • 18 Herzallah IR, Germani R, Casiano RR. Endoscopic transnasal study of the infratemporal fossa: a new orientation. Otolaryngol Head Neck Surg 2009; 140: 861-865
    CrossrefPubMedGoogle Scholar
  • 19 Battaglia P, Turri-Zanoni M, Dallan I , et al. Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors. Otolaryngol Head Neck Surg 2014; 150: 696-702
    CrossrefPubMedGoogle Scholar
  • 20 Fortes FS, Sennes LU, Carrau RL , et al. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model. Laryngoscope 2008; 118 (1) 44-49
    CrossrefPubMedGoogle Scholar
  • 21 Lee DL, McCoul ED, Anand VK, Schwartz TH. Endoscopic endonasal access to the jugular foramen: defining the surgical approach. J Neurol Surg B Skull Base 2012; 73 (5) 342-351
    PubMedGoogle Scholar
  • 22 Sessions RB, Larson DL. En bloc ethmoidectomy and medial maxillectomy. Arch Otolaryngol 1977; 103 (4) 195-202
    CrossrefPubMedGoogle Scholar
  • 23 Kamel RH. Transnasal endoscopic medial maxillectomy in inverted papilloma. Laryngoscope 1995; 105 (8 Pt 1): 847-853
    CrossrefPubMedGoogle Scholar
  • 24 Gras-Cabrerizo JR, Massegur-Solench H, Pujol-Olmo A , et al. Endoscopic medial maxillectomy with preservation of inferior turbinate: how do we do it?. Eur Arch Otorhinolaryngol 2011; 268: 389-392
    CrossrefPubMedGoogle Scholar
  • 25 Nakayama T, Asaka D, Okushi T, Yoshikawa M, Moriyama H, Otori N. Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct. Am J Rhinol Allergy 2012; 26 (5) 405-408
    CrossrefPubMedGoogle Scholar
  • 26 Robinson S, Patel N, Wormald PJ. Endoscopic management of benign tumors extending into the infratemporal fossa: a two-surgeon transnasal approach. Laryngoscope 2005; 115 (10) 1818-1822
    CrossrefPubMedGoogle Scholar
  • 27 Ramakrishnan VR, Suh JD, Chiu AG, Palmer JN. Septal dislocation for endoscopic access of the anterolateral maxillary sinus and infratemporal fossa. Am J Rhinol Allergy 2011; 25 (2) 128-130
    CrossrefPubMedGoogle Scholar
  • 28 Denker A. Ein Neuer Weg Fur Operation der malignen Nasentumoren. Munch Med Wochenschr 1906; 20: 953-956
    PubMedGoogle Scholar
  • 29 Canfield R. The submucous resection of the lateral nasal wall in chronic empyema of the antrum, ethmoid and sphenoid. J Am Med Assoc 1908; LI: 1136-1141
    PubMedGoogle Scholar
  • 30 Sturmann D. Die intranasale Eroffnung der Kieferhohle. Berliner Klinische Wochenschrift 1908; 45: 1273-1274
    PubMedGoogle Scholar
  • 31 Lombardi D, Tomenzoli D, Buttà L , et al. Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: a reassessment after 212 cases. Head Neck 2011; 33 (8) 1154-1161
    CrossrefPubMedGoogle Scholar
  • 32 Tomenzoli D, Castelnuovo P, Pagella F , et al. Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience with 47 patients. Laryngoscope 2004; 114 (2) 193-200
    CrossrefPubMedGoogle Scholar
  • 33 Brors D, Schafers M, Schick B. An endonasal approach to treating inverted papillomas of the nose and paranasal sinuses. Eur Arch Otorhinolaryngol 2000; 257: 94
    PubMedGoogle Scholar
  • 34 Carta F, Blancal JP, Verillaud B , et al. Surgical management of inverted papilloma: approaching a new standard for surgery. Head Neck 2013; 35 (10) 1415-1420
    PubMedGoogle Scholar
  • 35 Brors DD, Draf W. The treatment of inverted papilloma. Curr Opin Otolaryngol Head Neck Surg 1999; 7 (1) 33-38
    CrossrefPubMedGoogle Scholar
  • 36 El-Sayed I, Pletcher S, Russell M, McDermott M, Parsa A. Endoscopic anterior maxillotomy: infratemporal fossa via transnasal approach. Laryngoscope 2011; 121 (4) 694-698
    CrossrefPubMedGoogle Scholar
  • 37 DeFreitas J, Lucente FE. The Caldwell-Luc procedure: institutional review of 670 cases: 1975–1985. Laryngoscope 1988; 98 (12) 1297-1300
    PubMedGoogle Scholar
  • 38 Stefánsson P, Andréasson L, Jannert M. Caldwell-Luc operation: long-term results and sequelaes. Acta Otolaryngol Suppl 1988; 449: 97-100
    PubMedGoogle Scholar