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DOI: 10.1055/s-0035-1564057
Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae
Publikationsverlauf
08. Juni 2015
13. Juli 2015
Publikationsdatum:
09. September 2015 (online)
![](https://www.thieme-connect.de/media/jnlsb/201601/lookinside/thumbnails/10-1055-s-0035-1564057_150071-1.jpg)
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.
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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
- 2 Fisch U. Infratemporal fossa approach for lesions in the temporal bone and base of the skull. Adv Otorhinolaryngol 1984; 34: 254-266
- 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
- 4 Janecka IP. Classification of facial translocation approach to the skull base. Otolaryngol Head Neck Surg 1995; 112: 579-585
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 22 Sessions RB, Larson DL. En bloc ethmoidectomy and medial maxillectomy. Arch Otolaryngol 1977; 103 (4) 195-202
- 23 Kamel RH. Transnasal endoscopic medial maxillectomy in inverted papilloma. Laryngoscope 1995; 105 (8 Pt 1): 847-853
- 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
- 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
- 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
- 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
- 28 Denker A. Ein Neuer Weg Fur Operation der malignen Nasentumoren. Munch Med Wochenschr 1906; 20: 953-956
- 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
- 30 Sturmann D. Die intranasale Eroffnung der Kieferhohle. Berliner Klinische Wochenschrift 1908; 45: 1273-1274
- 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
- 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
- 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
- 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
- 35 Brors DD, Draf W. The treatment of inverted papilloma. Curr Opin Otolaryngol Head Neck Surg 1999; 7 (1) 33-38
- 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
- 37 DeFreitas J, Lucente FE. The Caldwell-Luc procedure: institutional review of 670 cases: 1975–1985. Laryngoscope 1988; 98 (12) 1297-1300
- 38 Stefánsson P, Andréasson L, Jannert M. Caldwell-Luc operation: long-term results and sequelaes. Acta Otolaryngol Suppl 1988; 449: 97-100