Graduated endoscopic multiangle approach for access to the infratemporal fossa: A cadaveric study with clinical correlates

TY - JOUR

T1 - Graduated endoscopic multiangle approach for access to the infratemporal fossa

T2 - A cadaveric study with clinical correlates

AU - Eloy, Jean Anderson

AU - Murray, Kim P.

AU - Friedel, Mark E.

AU - Tessema, Belachew

AU - Liu, James K.

PY - 2012/8

Y1 - 2012/8

N2 - Objective. The infratemporal fossa (ITF) has historically been one of the most difficult regions of the skull base to access surgically. Available open approaches are complex, are associated with high morbidity, and do not always afford optimal visualization. Endoscopic access to the ITF improves visualization for management of many sinonasal and lateral skull base lesions involving this region. The purpose of this study is to evaluate a graduated multiangle approach for endoscopic access to this area using a cadaveric model. Study Design and Setting. Cadaveric study at an academic medical center. Methods. Endoscopic dissection was performed on a total of 10 sides of 5 fresh cadaveric heads. Four different approaches to the ITF were studied: ipsilateral endonasal, endoscopically assisted Caldwell-Luc, contralateral endonasal via septotomy, and endoscopically assisted Gillies transtemporal. High-quality endoscopic pictures and high-definition videos of each technique were obtained in order to document the differences in access achieved with each approach. Results. The combination of the 4 different endoscopic techniques allowed complete access to all areas of the ITF. The endoscopically assisted Caldwell-Luc improved anteroposterior access, the contralateral septotomy approach resulted in excellent far lateral access, and the endoscopically assisted Gillies approach allowed posterosuperior visualization and instrumentation. Conclusion. Endoscopic access to the ITF can be accomplished by each of the 4 methods described. A multiangle, graduated approach can provide surgeons the ability to customize surgical access depending on the location of a specific lesion within the ITF.

AB - Objective. The infratemporal fossa (ITF) has historically been one of the most difficult regions of the skull base to access surgically. Available open approaches are complex, are associated with high morbidity, and do not always afford optimal visualization. Endoscopic access to the ITF improves visualization for management of many sinonasal and lateral skull base lesions involving this region. The purpose of this study is to evaluate a graduated multiangle approach for endoscopic access to this area using a cadaveric model. Study Design and Setting. Cadaveric study at an academic medical center. Methods. Endoscopic dissection was performed on a total of 10 sides of 5 fresh cadaveric heads. Four different approaches to the ITF were studied: ipsilateral endonasal, endoscopically assisted Caldwell-Luc, contralateral endonasal via septotomy, and endoscopically assisted Gillies transtemporal. High-quality endoscopic pictures and high-definition videos of each technique were obtained in order to document the differences in access achieved with each approach. Results. The combination of the 4 different endoscopic techniques allowed complete access to all areas of the ITF. The endoscopically assisted Caldwell-Luc improved anteroposterior access, the contralateral septotomy approach resulted in excellent far lateral access, and the endoscopically assisted Gillies approach allowed posterosuperior visualization and instrumentation. Conclusion. Endoscopic access to the ITF can be accomplished by each of the 4 methods described. A multiangle, graduated approach can provide surgeons the ability to customize surgical access depending on the location of a specific lesion within the ITF.

KW - Caldwell-Luc

KW - Gillies

KW - anatomic study

KW - cadaveric study

KW - endoscopic skull base surgery

KW - infratemporal fossa

KW - multiangle infratemporal fossa approach

KW - transnasal septotomy

KW - transseptal

UR - https://www.scopus.com/pages/publications/84867372755

UR - https://www.scopus.com/pages/publications/84867372755#tab=citedBy

U2 - 10.1177/0194599812442612

DO - 10.1177/0194599812442612

M3 - Article

C2 - 22470157

SN - 0194-5998

VL - 147

SP - 369

EP - 378

JO - Otolaryngology - Head and Neck Surgery (United States)

JF - Otolaryngology - Head and Neck Surgery (United States)

IS - 2

ER -