Microsurgical anatomy of the infratemporal fossa

Abstract

The objective of this study is to clearly and precisely describe the topography and contents of the infratemporal fossa. Ten formalin-fixed, adult cadaveric specimens were studied. Twenty infratemporal fossa were dissected and examined using micro-operative techniques with magnifications of 3-40×. Information was obtained about the inter-relationships of the contents of the infratemporal fossa. The infratemporal fossa lies at the boundary of the head and neck, and the intracranial cavity. It is surrounded by the maxillary sinus anteriorly, the mandible laterally, the pterygoid process anteromedially, and the parapharyngeal space posteromedially. It contains the maxillary artery and its branches, the pterygoid muscles, the mandibular nerve, and the pterygoid venous plexus. The course and the anatomic variation of the maxillary artery and the branches of the mandibular nerve were demonstrated. The three-dimensional (3D) relationships between the important bony landmarks and the neurovascular bundles of the infratemporal fossa were also shown. The skull base anatomy of the infratemporal fossa is complex, requiring neurosurgeons and head and neck surgeons to have a precise knowledge of 3D details of the topography and contents of the region. A detailed 3D anatomic knowledge is mandatory to manage benign or malignant lesions involving the infratemporal fossa without significant postoperative complications.

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“…The natural space of the maxillary sinus makes the procedure fairly safe and simple; however, these approaches provide minimal exposure with relatively distal access, which can especially limit the resection of larger tumors and often require transfacial incisions. 8,9 This same limitation also applies to endoscopic techniques of accessing the anterior skull base. Endoscopy has been used for resection of other vascular tumors, such as angiofibromas, but large lateral lesions with significant involvement of critical anatomical structures like the internal carotid artery and dura, as seen in our patient, are more safely accessed via the transfacial or infratemporal fossa approaches.…”

“…8,9 The specific location of the tumor within this space, along with its relationship to nearby structures and extension into any adjacent compartments (e.g., the orbit, cranial vault, etc. ), remain the primary determinants in the selection of the most appropriate surgical approach.…”

“…According to Joo et al, these techniques can be grouped into two main categories: anterior and lateral (Isolan et al and Otremba et al have further suggested "inferior" as a third category to encompass the transmandibular and transcervical approaches). 7,9 Among the lateral approaches, the Fisch type A, B, C, and D procedures are regarded as some of the most revolutionary for their ability to permit treatment of lesions involving the temporal bone and skull base. 7 Variations on these procedures, such as the preauricular subtemporal approach described by Sekhar, have also been described.…”

“…However, although these approaches do permit good exposure and vascular control, access to tumors extending medial to the pterygomaxillary fissure or across the midline is one of several recognized limitations to this approach. 7,9 Among the anterior routes of access, the transmaxillary approach is one of the more common means of accessing the ITF, particularly for tumors extending to the nasopharynx. The natural space of the maxillary sinus makes the procedure fairly safe and simple; however, these approaches provide minimal exposure with relatively distal access, which can especially limit the resection of larger tumors and often require transfacial incisions.…”

A Conceptual Study on Kaphaja Shiroroga with Special Reference to Sinusitis

“…It extends from the front wall of the middle ear to the side wall of the nasopharynx, passing along the posterior edge of the medial pterygoid plate; proceeding forward and downwards and medially, to form a 45 degree angle with respect to the sagittal plane, and at an angle of about 30 degrees to the horizontal plane [6].…”