Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

Abstract

OBJECTIVES:Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa.METHOD:We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor.RESULTS:No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome.CONCLUSION:The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.

Advanced Endoscopic Endonasal Approach to the Pterygopalatine Fossa and Orbit: The Endoscopic Tri-port Approach

“…While tumors in the PPF and orbit have been typically treated with external incisions, this approach has been increasingly replaced by endoscopic resections, which do not leave facial scars, as the mainstream surgical approach. [1][2][3][4][5] As endoscopic surgery requires manipulation through a narrow corridor, however, the operation requires more dexterity than the open approach. Several techniques have been reported to broaden the surgical approach and improve the surgical strategy.…”

“…Located posterior to the maxillary sinus, the pterygopalatine fossa (PPF) is a narrow space that communicates medially with the nasal cavity through the pterygopalatine foramen; laterally with the infratemporal fossa through the pterygomaxillary fissure; superiorly with the middle cranial fossa through the foramen rotundum, which contains V2; anteriorly with the orbit through the inferior orbital fissure; and inferiorly with the oral cavity through the descending palatine canal, which projects to the greater and lesser palatine foramina. [1][2][3][4][5] The PPF is occasionally involved in cases of juvenile angiofibroma and malignant tumors. When surgical intervention is required, the PPF is typically accessed with an external approach, which elevates the risk facial scarring and deformity.…”

“…When surgical intervention is required, the PPF is typically accessed with an external approach, which elevates the risk facial scarring and deformity. However, the development of endoscopic instruments and techniques has allowed the PPF to be accessed endoscopically [1][2][3][4][5] ; this strategy is less invasive, without facial scarring and deformity, and allows for a clearer surgical field. Moreover, the angled endoscope with which it is used reveals objects that are typically obscured by shadow.…”

Endoscopic trans nasal excision of pterygopalatine fossa schwannoma: case report and review of literature

“…Primary tumors of the PPF, such as meningioma, schwannoma or nasopharyngeal angiofibroma, are rare, most common are sinonasal tumors which frequently extend into the PPF. 2 PPF lesions although benign, are challenging to surgeons in terms of access because of their deep location. Achieving surgical clearance is difficult due to their close proximity to various vital structures such as arteries and cranial nerves.…”

“…An endoscopic approach to the PPF can overcome most of the disadvantages of open techniques with better visualization of these difficult-toaccess locations with decreased morbidity and shorter post-operative recovery periods. 1,2…”