Transvestibular Approach to Middle Cranial Base Feasible

Allows safe exposure, exploration, resection of infratemporal fossa, parapharyngeal space lesions

MONDAY, Oct. 31 (HealthDay News) -- Use of a transvestibular endoscopic approach allows safe exposure, exploration, and resection of lesions in the infratemporal fossa (ITF) and parapharyngeal space (PPS), according to a study published in the October issue of The Laryngoscope.

Jason Y.K. Chan, M.B.B.S., from Johns Hopkins Medical Institutions in Baltimore, and colleagues described the surgical technique and clinical feasibility of a new transvestibular endoscopic approach for the exposure, exploration, and resection of lesions involving the right-sided ITF and PPS in four patients. A hardy speculum was used to maintain the optical corridor to the ITF and PPS created through a vertical oral mucosal incision along the ascending ramus of the mandible, and the contents were examined through a 0-degree 4-mm rigid endoscope.

The investigators found that the technique gave access and exposure to the area from the middle cranial base at the level of the foramen ovale to the mid-PPS. It provided safe exploration and preservation of the branches of the trigeminal nerve in the ITF, and exposure and visualization of the internal maxillary artery and its branches. Using this approach, two patients underwent resection of a primary and a recurrent pleomorphic adenoma, chronic pain relief from a large synovial chondromatosis was achieved in one patient, and debulking of recurrent mucoepidermoid carcinoma was carried out in one patient. Complications were self-limiting hypoesthesia and transient dysphagia in one patient each.

"The transvestibular endoscopic approach to the ITF and PPS is a minimally invasive option for exploring this difficult-to-access area," the authors write.

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