Endoscopic transvestibular paramandibular exploration of the infratemporal fossa and parapharyngeal space: A minimally invasive approach to the middle cranial base

Abstract

The transvestibular endoscopic approach to the ITF and PPS offers direct and minimally invasive access to select lesions within this region. Further use of this approach will allow us to determine its potential and limitations.

Fronto-Temporo-Zygomatic Approach for Orbital Apex and Infratemporal Fossa

“…An endoscopic endonasal ITF approach may provide the access required for the resection of a tumor, or it may be adjunctive to other approaches, such as transcranial-subtemporal, Le Fort I, transmaxillary, or anterior subfrontal approaches [6].…”

Surgical anatomy of the parapharyngeal space: Multiperspective, quantification‐based study

“…2,3 The prevalent benign nature of PPTs should prompt the surgeon to minimize surgical morbidity. [5][6][7][8][9] In addition, several technical refinements, such as endoscope-assisted dissection, intraoperative neuromonitoring, and debrider-assisted cavitation, were introduced to minimize surgical morbidity without affecting radicality of resection. For the same reasons, whenever imaging and/or cytology suggests the benign nature of a PPT, a "wait and see" policy may also be adopted in asymptomatic or slow-growing lesions, especially in patients with severe comorbidities.…”

Analysis of the far‐medial transoral endoscopic approach to the infratemporal fossa

“…Anteriorly, it is bounded by the posterolateral maxillary sinus wall (PMSW) and posteriorly by the carotid space. Medially, it is limited by the lateral surface of the lateral pterygoid plate (LPP) and pterygomaxillary fissure (PMF), whereas laterally, its borders are formed by the temporalis muscle (TpM) and the mandible . Inferiorly, the region opens into the parapharyngeal space (PPS) .…”

“…Medially, it is limited by the lateral surface of the lateral pterygoid plate (LPP) and pterygomaxillary fissure (PMF), whereas laterally, its borders are formed by the temporalis muscle (TpM) and the mandible . Inferiorly, the region opens into the parapharyngeal space (PPS) . Despite the rarity of neoplastic lesions affecting the ITF, either arising or invading from adjacent structures, the region's critical anatomic position has long captivated the interest of an array of surgical specialties .…”

“…Despite multiple studies expressing the value of EEA as a feasible strategy for the management of ITF lesions, its indications are limited . To overcome this difficulty, yet continue experiencing the benefits of endoscopy, alternative routes of access are constantly being investigated …”