Abstract:Endoscopic approaches have been used to manage a variety of disease processes that extend beyond the confines of the paranasal sinuses. Invasive fungal sinusitis disease with extension into the infratemporal fossa can be safely debrided via a transnasal endoscopic technique. The approach provides excellent visualization with low morbidity.
“…The PPF can be involved by the spread of invasive fungal sinusitis, bacterial sinusitis, and less often, in inflammatory conditions like inflammatory pseudotumour (IPT) [ 35 – 41 ].…”
Section: Neoplastic Conditionsmentioning
confidence: 99%
“…From the PPF, the disease shows easy access to the middle cranial fossa and cavernous sinus, leading to serious complications like cavernous sinus thrombosis, arterial mycotic aneurysms, infarcts, and abscesses. Extension into the PPF and ITF require rapid surgical debridement (which can be often very challenging in this area) in addition to aggressive antifungal therapy [ 35 – 38 ]. Fig.…”
The pterygopalatine fossa (PPF) is a small, clinically inaccessible, fat-filled space located in the deep face that serves as a major neurovascular crossroad between the oral cavity, nasal cavity, nasopharynx, orbit, masticator space, and the middle cranial fossa. Due to its inherent complex location and connections, it can potentially act as a natural conduit for the spread of inflammatory and neoplastic diseases across the various deep spaces in the head and neck. This review aims to acquaint the reader with the imaging anatomy of the PPF, its important communications, and to identify some major pathological conditions that can involve the PPF, especially in conditions where its involvement can have serious diagnostic and therapeutic implications, such as in perineural tumour spread.Teaching points• The PPF is a small neurovascular junction in the deep face with important to-and-fro connections.• Awareness of anatomy of the PPF and its communications helps to simplify imaging of its pathology.• Perineural tumour spread is clinically the most important pathology in this region.
“…The PPF can be involved by the spread of invasive fungal sinusitis, bacterial sinusitis, and less often, in inflammatory conditions like inflammatory pseudotumour (IPT) [ 35 – 41 ].…”
Section: Neoplastic Conditionsmentioning
confidence: 99%
“…From the PPF, the disease shows easy access to the middle cranial fossa and cavernous sinus, leading to serious complications like cavernous sinus thrombosis, arterial mycotic aneurysms, infarcts, and abscesses. Extension into the PPF and ITF require rapid surgical debridement (which can be often very challenging in this area) in addition to aggressive antifungal therapy [ 35 – 38 ]. Fig.…”
The pterygopalatine fossa (PPF) is a small, clinically inaccessible, fat-filled space located in the deep face that serves as a major neurovascular crossroad between the oral cavity, nasal cavity, nasopharynx, orbit, masticator space, and the middle cranial fossa. Due to its inherent complex location and connections, it can potentially act as a natural conduit for the spread of inflammatory and neoplastic diseases across the various deep spaces in the head and neck. This review aims to acquaint the reader with the imaging anatomy of the PPF, its important communications, and to identify some major pathological conditions that can involve the PPF, especially in conditions where its involvement can have serious diagnostic and therapeutic implications, such as in perineural tumour spread.Teaching points• The PPF is a small neurovascular junction in the deep face with important to-and-fro connections.• Awareness of anatomy of the PPF and its communications helps to simplify imaging of its pathology.• Perineural tumour spread is clinically the most important pathology in this region.
“…Even in the age of ubiquitous image‐guided navigation, the distances to these landmarks provide a rapid means of confirming one's surgical position. Expanded endonasal endoscopic approaches are increasingly being used to surgically access the ITF 1–9. Two important landmarks have previously been identified to aid the endoscopic skull base surgeon in dissecting the ITF 10.…”
Average distance from the ANS to the AFO and BB was 78.5 mm and 83.2 mm, respectively. These measurements can be used by endoscopic skull base surgeons to guide dissection in the ITF.
“…14 An endoscopic approach to the infratemporal fossa, for the treatment of invasive fungal sinusitis, has recently been published. 15 An endoscopy-assisted antral window approach, for angiofibroma extending to the infratemporal fossa, has also been recently described. 16 Ong et al have recently described a transantral, transinfratemporal fossa approach to the rostral middle fossa, which faces the temporal pole and proceeds in the direction of the endocranial, anterosuperior aspect of the greater wing of the sphenoid.…”
This endoscopic two-surgeon technique is an excellent approach for managing angiofibroma extending to the pterygopalatine and infratemporal fossae. Our modification markedly decreased morbidity by avoiding septum opening and sublabial incision, and by enabling better haemostasis (via maxillary artery control). Recurrence may be minimised by careful examination of the lateral sphenoid wall, pterygoid canal and infratemporal fossa pterygoid muscles.
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