Combined Endoscopic Approaches Can Provide Maximal Exposure to the Infratemporal Fossa

by Linda Kossoff •

CLINICAL QUESTION

What are the benefits and caveats of combining minimal access endoscopic approaches to the infratemporal fossa (ITF) to address extensive lesions not amenable to a single approach?

BOTTOM LINE

Combining minimal access endoscopic approaches to the ITF can provide significantly greater exposure than an isolated endoscopic transnasal transpterygoid approach (EETA), thereby providing enhanced access to address lesions with extensive involvement of the ITF.

BACKGROUND: The ITF is a challenging area to access. Open approaches afford a panoramic exposure but may cause complications. Minimally invasive approaches are generally limited in the extent of exposure or control of the neurovascular structure; however, endoscopic procedures may be combined via multiple portals to provide maximal exposure that rivals open techniques.

STUDY DESIGN: Cadaver study

SETTING: Anatomy Laboratory Toward Visuospatial Surgical Innovations in Otolaryngology and Neurosurgery of the Wexner Medical Center of The Ohio State University

SYNOPSIS: Researchers aimed to provide a quantitative endoscopic anatomical description of the exposure and ease of instrumentation achieved with combined endoscopic approaches to accessing the ITF, while controlling all pertinent neurovascular structures. To that end, they dissected five human cadaveric specimens (10 sides) using the following minimal access approaches: EETA, endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques. Area of exposure at the pterygopalatine fossa and surgical freedom at the ITF were obtained for each approach, and video recordings and images of the dissections were captured. “Area of exposure” was calculated using three fixed and two variable points. “Surgical freedom” was defined as the maximal oval area along which the proximal end of the endoscope can be freely and easily moved with the distal end of the instrument fixed on a target. The area of exposure and surgical freedom were compared among the combined approaches, the endoscopic sublabial transmaxillary approach, and EETA. Results showed that the endoscopic sublabial transmaxillary sinus and the combined approach afforded a significantly greater exposure than an isolated EETA, thus confirming the feasibility of controlling the ITF using multi-corridor combined approaches.

CITATION: Mongkolkul K, Salem EH, Alsavaf MB, et al. Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques. Laryngoscope Investig Otolarygol. 2024;9:e1242.doi: 10.1002/lio2.1242.