Abstract

Introduction: Endonasal approaches with endoscopic assistance are generally preferred for accessing the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). To improve exposure of these regions, several extended maxillary sinus approaches and external accesses have been described. Objectives: To determine whether the endonasal medial transmaxillary (MTM) approach provide adequate exposure of the PPF and ITF. Methods: Patients treated for pathologies involving the PPF and/or ITF were included. The surgical technique consisted of performing a wide middle maxillary antrostomy, followed by opening the posterior bony wall of the maxillary sinus to expose the PPF. The MTM approach was considered adequate when it provided sufficient exposure of the lesion without requiring an extended maxillary approach or external access. Results: Twenty-eight endonasal endoscopic approaches were performed for various pathologies originating in or extending into the PPF. Endonasal exposure of the PPF was adequate in all patients, and no intraoperative modifications of the surgical plan were required. No major complications occurred. Conclusion: The MTM endonasal approach effectively exposed all relevant structures of the PPF and ITF, from the vidian nerve to V3. No extended endonasal maxillary approaches or external accesses were required for biopsies or complete resections

Keywords

endoscopic surgery, pterygopalatine fossa, infratemporal fossa, maxillary antrostomy