Transnasal endoscopic management of angiofibroma extending to pterygopalatine and infratemporal fossae

Abstract

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.

Endoscopic Endonasal Transpterygoid Transmaxillary Approach to the Infratemporal and Upper Parapharyngeal Tumors

“…The first experiences focused mainly on the treatment of benign lesions such as JNA, which is the most common tumor extending into these areas. 16,[22][23][24][25] In this context, Nicolai et al 26 reported 17 cases of laterally extended JNA (14: stage IIIA; 3: stage IIIB) in a series of 46 patients radically resected through an EEA. In the past few years, improvement of endoscopic instruments and neuronavigation systems and advances in radiology (preoperative evaluation and interventional procedures) and anesthetic techniques have all contributed to allow the management even of malignancies extending into the ITF/ UPS.…”

“…Recently, there has been increasing interest in the endoscopic endonasal management of ITF/UPS tumors. The first experiences focused mainly on the treatment of benign lesions such as JNA, which is the most common tumor extending into these areas 16,22‐25 . In this context, Nicolai et al 26 reported 17 cases of laterally extended JNA (14: stage IIIA; 3: stage IIIB) in a series of 46 patients radically resected through an EEA.…”

Microsurgical anatomy of the infratemporal fossa

“…The major drawbacks of endoscopic surgery in the infratemporal fossa are the difficulty in controlling hemorrhage from the abundant and highly variable vasculature, and the difficulty in physically accessing the lesion as the dissection proceeds more laterally (Kassam et al, 2005). Recently, a two‐surgeon endoscopic technique was developed to maintain the visibility and continuing dissection of lesions (Robinson et al, 2005; El Morsy and Khafagy, 2011). The endoscopic approach is limited in reaching the infratemporal area lateral and superior to the principle neurovascular structures.…”

Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature

“…However, it could give us some comparative information. Moreover, we reviewed all the studies 7-24,31…”

“…Patients' characteristics. In our review, we have found 7 prospective studies 8,10,[19][20][21][22][23] with 124 patients treated by endoscopic resection of JNA, with an average of 17.7 per study and a maximum of 28. 10 We found only 1 prospective comparative study 8 that was not a RCT.…”