Background: The purpose of this study was to assess the feasibility of the endoscopic transoral approach for resection of retrostyloid benign tumors. Methods: We retrospectively reviewed 16 patients with retrostyloid parapharyngeal space (PPS) tumors resected via an endoscopic transoral approach. After separation and control of the internal carotid artery (ICA), tumors in the retrostyloid PPS were then removed under the guidance of angled endoscope (45). Results: All 16 patients with retrostyloid PPS tumors were successfully removed via an endoscopic transoral approach. There were 15 schwannomas and 1 paraganglioma. Two tumors were removed en bloc, and the other 14 tumors were removed by piecemeal. In five patients, the tumor extended into the jugular foramen, and was completely removed via the transoral corridor, without cerebrospinal fluid leak. No ICA injury was encountered in any of the 16 patients. Conclusion: The endoscopic transoral approach is suitable for the resection of retrostyloid PPS tumors and is associated with low morbidity.
Background: The infratemporal fossa (ITF) represents an area densely packed with neurovascular structures within irregular boundaries. The goal of this study was to classify the ITF into zones corresponding to its anatomical spaces and the order in which they are encountered during an endonasal approach (anteroposterior axis). Methods: Six cadaveric specimens (12 sides) with injected colored latex were dissected. Following an endoscopic medial maxillectomy and Denker's approach, a progressive exploration of the masticator space and upper parapharyngeal space was completed. A classification of the ITF based on welldefined spaces was ascertained. Results: The ITF was divided into five zones:• Zone 1 (retromaxillary space)-space lying between the posterolateral wall of the maxillary sinus and the temporalis and pterygoid muscles. • Zone 2 (superior interpterygoid space)-area including the superior head of the lateral pterygoid muscle, V 3 , and foramen ovale. • Zone 3 (inferior interpterygoid space)-includes the inferior head of lateral pterygoid muscle, medial pterygoid, and temporalis muscles, and the space enclosed by these muscles. • Zone 4 (temporo-masseteric space)-space lateral to the temporalis muscle (comprising fat mostly). • Zone 5 (tubopharyngeal space)-includes the Eustachian tube, tensor, and levator veli palatini muscles, and structures in upper parapharyngeal space. Conclusion: The ITF can be visualized as five zones based on spaces enclosed by the masticator muscles and upper parapharyngeal structures. This novel classification system is useful to guide endoscopic approaches to the ITF, while decreasing the potential for injury of neurovascular structures and pterygoid muscles. K E Y W O R D S endoscopic Denker's approach, infratemporal fossa, muscles of mastication, pterygoid muscle, transpterygoid Lifeng Li and Nyall R. London Jr. contributed equally to this work.
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