Jung Joo Lee1, Gwanghui Ryu1, Hyo Yeol Kim1, Hun-Jong Dhong1, Seung-Kyu Chung1, Sang Duk Hong2. 1. Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 2. Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: kkam97@gmail.com.
Abstract
BACKGROUND: Endoscopic endonasal approach to infratemporal fossa (ITF) had gained popularity. However, the inferior turbinate and/or lacrimal duct are often removed when performing endoscopic medial maxillectomy for ITF approach and there were potential risk of empty nose syndrome or epiphora. Although endoscopic prelacrimal recess approach (EPRA) had been introduced to avoid these complications, there were some limitations associated with surgical freedom. The objective was to report the two-port endoscopic technique using both prelacrimal recess and antral window as a means to preserve inferior turbinate and lacrimal duct while facilitating instrument availability during ITF tumor resection. METHODS: We retrospectively reviewed three patients between September 2016 and May 2018 who were treated with this modified two port technique for ITF tumors. RESULTS: There was one case of trigeminal schwannoma originating in the mandibular nerve, one recurrent meningioma, and one paraganglioma. This two-port technique was not initially scheduled in these three cases but decided during surgery because tumors were extensively attached to surrounding muscles and have profuse bleeding. After tumor resection, sinonasal anatomy such as inferior turbinate or lacrimal duct was well preserved. CONCLUSIONS: We propose a hybrid endoscopic surgical procedure for ITF tumors using both EPRA and transantral window. It allows the surgeons to have an advantage of utilizing an adequate working space by bimanual technique through different two ports while preserving normal sinonasal structures.
BACKGROUND: Endoscopic endonasal approach to infratemporal fossa (ITF) had gained popularity. However, the inferior turbinate and/or lacrimal duct are often removed when performing endoscopic medial maxillectomy for ITF approach and there were potential risk of empty nose syndrome or epiphora. Although endoscopic prelacrimal recess approach (EPRA) had been introduced to avoid these complications, there were some limitations associated with surgical freedom. The objective was to report the two-port endoscopic technique using both prelacrimal recess and antral window as a means to preserve inferior turbinate and lacrimal duct while facilitating instrument availability during ITF tumor resection. METHODS: We retrospectively reviewed three patients between September 2016 and May 2018 who were treated with this modified two port technique for ITF tumors. RESULTS: There was one case of trigeminal schwannoma originating in the mandibular nerve, one recurrent meningioma, and one paraganglioma. This two-port technique was not initially scheduled in these three cases but decided during surgery because tumors were extensively attached to surrounding muscles and have profuse bleeding. After tumor resection, sinonasal anatomy such as inferior turbinate or lacrimal duct was well preserved. CONCLUSIONS: We propose a hybrid endoscopic surgical procedure for ITF tumors using both EPRA and transantral window. It allows the surgeons to have an advantage of utilizing an adequate working space by bimanual technique through different two ports while preserving normal sinonasal structures.