Lifeng Li1,2, Nyall R London2,3,4, Daniel M Prevedello2,5, Ricardo L Carrau2,5. 1. Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China. 2. Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, USA. 3. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 4. Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA. 5. Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, USA.
Abstract
BACKGROUND: Lesions of the upper parapharyngeal space (UPPS) present a surgical challenge. The objective of this study was to ascertain the feasibility of a novel technique of modified transpterygoid approach to the UPPS. METHODS: Six fresh cadaveric specimens (12 sides) were dissected, developing a technique that includes en bloc mobilization of the lateral pterygoid plate and muscle to access the UPPS. RESULTS: Following an endoscopic Denker's approach and the removal of posterolateral wall of the antrum, the lateral pterygoid plate was detached from the pterygoid process. Subsequently, the lateral pterygoid plate and muscle were displaced laterally as a unit, allowing the identification of the posterior trunk of V3 and the fat in prestyloid compartment. Dissecting off the styloid aponeurosis affords entering the poststyloid UPPS exposing the internal carotid artery, internal jugular vein, and cranial nerves IX to XII. CONCLUSION: This novel modification of the endonasal transpterygoid approach offers a viable alternative for access to the UPPS.
BACKGROUND: Lesions of the upper parapharyngeal space (UPPS) present a surgical challenge. The objective of this study was to ascertain the feasibility of a novel technique of modified transpterygoid approach to the UPPS. METHODS: Six fresh cadaveric specimens (12 sides) were dissected, developing a technique that includes en bloc mobilization of the lateral pterygoid plate and muscle to access the UPPS. RESULTS: Following an endoscopic Denker's approach and the removal of posterolateral wall of the antrum, the lateral pterygoid plate was detached from the pterygoid process. Subsequently, the lateral pterygoid plate and muscle were displaced laterally as a unit, allowing the identification of the posterior trunk of V3 and the fat in prestyloid compartment. Dissecting off the styloid aponeurosis affords entering the poststyloid UPPS exposing the internal carotid artery, internal jugular vein, and cranial nerves IX to XII. CONCLUSION: This novel modification of the endonasal transpterygoid approach offers a viable alternative for access to the UPPS.
Authors: Lifeng Li; Bentao Yang; Xiaobo Ma; Pingdong Li; Francis X Creighton; Ricardo L Carrau; Nyall R London Journal: J Neurol Surg B Skull Base Date: 2021-01-14
Authors: Franco DeMonte; Shaan M Raza; Solon Schur; Joel Z Passer; Ehab Y Hanna; Shirley Y Su; Michael E Kupferman Journal: J Neurooncol Date: 2022-08-16 Impact factor: 4.506