1
|
Mongkolkul K, Salem EH, Alsavaf MB, Prevedello DM, Vankoevering K, Kelly K, Carrau RL. Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques. Laryngoscope Investig Otolaryngol 2024; 9:e1242. [PMID: 38736945 PMCID: PMC11081421 DOI: 10.1002/lio2.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024] Open
Abstract
Objective Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital, endoscopic transoral, and endoscopic sublabial transmaxillary approaches to address extensive lesions not amenable to a single approach. The study provides anatomical metrics including area of exposure and degree of surgical freedom. Methods Five human cadaveric specimens (10 sides) were dissected to expose and methodically analyze the anatomical intricacies of the ITF using the following minimal access approaches: endoscopic transnasal transpterygoid (EETA), endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques. Area of exposure at the pterygopalatine fossa and surgical freedom at the ITF were obtained for each approach. Results The endoscopic sublabial transmaxillary sinus and the combined approach afford a significantly greater exposure than an isolated EETA. The difference in exposure (mean) between the endoscopic sublabial transmaxillary and EETA was 1.62 ± 0.85 cm2 (p < 0.001), and the difference between the combined approach and EETA was 4.25 ± 0.85 cm2 (p < 0.001). Conclusions Combining minimal access endoscopic approaches to the ITF can provide significantly greater exposure than an isolated EETA; thus, providing enhanced access to address lesions with extensive involvement of the ITF, especially those with superolateral and inferolateral extensions. In addition, some approaches may have an adjunctive role to the resection, such as the endoscopic transoral approach offering the potential for early control of the internal maxillary artery and its branches, some of which may be supplying the tumor in the ITF; or the endoscopic transorbital approach yielding a direct line of sight to the superior ITF and middle cranial fossa. Level of Evidence NA.
Collapse
Affiliation(s)
- Kittichai Mongkolkul
- Excellence Center in Otolaryngology Head & Neck SurgeryRajavithi HospitalBangkokThailand
- Rangsit University College of MedicineMueang Pathum ThaniThailand
| | - Eman H. Salem
- Otorhinolaryngology‐Head and Neck SurgeryMansoura University HospitalsMansouraEgypt
| | - Mohammad Bilal Alsavaf
- Otolaryngology‐Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | | | | | - Kathleen Kelly
- Otolaryngology‐Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Ricardo L. Carrau
- Otolaryngology‐Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| |
Collapse
|
2
|
Cao Z, Wang T, Lin B, Cai B, Peng H, Liu H, Liao J. Infratemporal Fossa Schwannoma Surgery via a Combined Prelacrimal Recess, Caldwell-Luc, and Distal Intraoral Approach. J Craniofac Surg 2024:00001665-990000000-01311. [PMID: 38299847 DOI: 10.1097/scs.0000000000009947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The deep location of infratemporal fossa (ITF) combined with the abundant vascular plexus in it increased the difficulty of removing the mass in ITF through endoscope surgery approach. However, under appropriate circumstances, the excision of ITF tumors through a combined prelacrimal recess, Caldwell-Luc, and distal intraoral approach can be safely performed with minimal impact on the surrounding tissues. CASE PRESENTATION The Department of Neurology received a 69-year-old male patient who had been experiencing headache, dizziness, and numbness from the mastoid region of his left ear to the corner of his mouth for a duration of 22 days. Cranial magnetic resonance imaging revealed the presence of a tumor located in the ITF. Following transfer to our department, surgical intervention was performed using a combined approach involving the prelacrimal recess, the anterior wall of maxillary sinus, and lateral ITF to successfully remove the tumor. Postoperative pathologic examination confirmed schwannoma as its nature. The patient was discharged in excellent condition without any functional impairment. CONCLUSIONS On the basis of this case, the authors believe that this combined approach can offer a distinct endoscopic perspective and adequate surgical workspace, which is crucial for tumor removal while preserving the integrity of surrounding normal tissues. Moreover, the utilization of multiple small incisions has minimal impact on postoperative recovery.
Collapse
Affiliation(s)
- Zhiwen Cao
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Naval Medical University
- Department of Otolaryngology-Head and Neck Surgery, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Tianyu Wang
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Naval Medical University
| | - Bojian Lin
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Naval Medical University
| | - Boyu Cai
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Naval Medical University
| | - Hu Peng
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Naval Medical University
| | - Huanhai Liu
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Naval Medical University
| | - Jianchun Liao
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Naval Medical University
| |
Collapse
|
3
|
Li L, Chen X. Advances in Endoscopic Surgical Approaches for Sinonasal Tumors. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023. [DOI: 10.1007/s40136-023-00449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
|
4
|
Mongkolkul K, Alsavaf MB, Salem EH, VanKoevering KK, Kelly K, Hardesty DA, Prevedello DM, Carrau RL. Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa. Laryngoscope 2023; 133:1367-1374. [PMID: 36752574 DOI: 10.1002/lary.30611] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To demonstrate anatomic relationships pertinent to the endoscopic multiport approach to the infratemporal fossa (ITF). Discuss advantages and limitations of each individual approach. STUDY DESIGN Cadaveric study. METHODS Endoscopic and endoscopic-assisted endonasal transpterygoid, sublabial transmaxillary, endoscopic transorbital, and endoscopic transoral approaches to accessing the ITF were completed in five silicone-injected fresh cadaveric specimens (10 sides) with the assistance of 0, 30, and 450 rods-lens endoscopes. Image guidance was used to confirm and document the anatomical relationships encountered in each approach. RESULTS The endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure to median structures. Endoscopic-assisted sublabial transmaxillary approach enhances the field of exposure, angle of attack, and ease of instrumentation to the lateral part of the ITF. Endoscopic-assisted transorbital approach via the inferior orbital fissure provided cephalic and anterior access. Endoscopic-assisted transoral approach complements the access to lesions extending inferior to the hard palate or far lateral to the mandibular condyle. CONCLUSIONS A combination of minimal access infratemporal approaches can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches. LEVEL OF EVIDENCE NA Laryngoscope, 2023.
Collapse
Affiliation(s)
- Kittichai Mongkolkul
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Excellence Center in Otolaryngology-Head & Neck Surgery Rajavithi Hospital, Bangkok, Thailand.,Department of Otolaryngology-Head & Neck Surgery, Rangsit University College of Medicine, Bangkok, Thailand
| | - Mohammad Bilal Alsavaf
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Eman H Salem
- Department of Otolaryngology-Head & Neck Surgery, Mansoura University Hospitals, Mansoura, Egypt
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Kathleen Kelly
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Douglas A Hardesty
- Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
5
|
Kikuchi M, Nakagawa T. Recent progress in endoscopic skull base surgery: Functional preservation and multiportal approaches. Auris Nasus Larynx 2023; 50:32-39. [PMID: 35440399 DOI: 10.1016/j.anl.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 01/28/2023]
Abstract
Over the past couple of decades, endoscopic skull base surgery (ESBS) has significantly evolved and is applied to a broad range of skull base pathologies, including sinonasal malignancies. Recent studies have demonstrated remarkable progress of ESBS in complete resection with low morbidity and extension of its application to larger and more complex lesions. In this review, we focus on the evolution of functional preservation and multiportal approaches. Progress in preoperative assessments and surgical techniques improved the preservation of olfactory function after ESBS. The technical feasibility of olfaction preservation even after resection of olfactory groove lesions has been reported. To overcome the limitations of extending use of the endoscopic endonasal approach in surgical fields, various types of multiportal approaches, including combinations of the endoscopic endonasal and transorbital, transmaxillary, or transoral approach, have been reported, as they are useful for complete resection of extensive pathologies while limiting morbidity. These innovative techniques are still in the process of maturation. Hence, an ongoing critical evaluation is essential to ensure efficacy.
Collapse
Affiliation(s)
- Masahiro Kikuchi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyoku, Kyoto 606-8507, Japan
| | - Takayuki Nakagawa
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyoku, Kyoto 606-8507, Japan.
| |
Collapse
|
6
|
Thaduri A, Kottayasamy Seenivasagam R, Majumdar KS, Usmani SA, Maharaj DD, Panuganti A. Trans-cervical mandibulotomy approach for a multi-compartmental trigeminal Schwannoma: A surgeon's guide. Oral Oncol 2021; 122:105572. [PMID: 34662772 DOI: 10.1016/j.oraloncology.2021.105572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022]
|
7
|
Soriano RM, Rindler RS, Helman SN, Pradilla G, Solares CA. Endoscopic transoral nasopharyngectomy. Head Neck 2020; 43:278-287. [PMID: 32996247 DOI: 10.1002/hed.26483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND A minimal access technique for the management of nasopharyngeal tumors extending below the palatal plane and laterally beyond the pterygoid musculature is yet to be developed. In this study we demonstrate the feasibility of endoscopic transoral nasopharyngectomy (ETON) for resection of large nasopharyngeal lesions as a natural orifice alternative to traditional approaches. METHODS ETON was completed in three latex-injected specimens. Surgical freedom (SF) and angles of attack (AoA) were calculated along the internal carotid artery (ICA). RESULTS An endoscopic transoral approach was successfully used to identify the parapharyngeal ICA and subsequently perform a complete nasopharyngeal resection. SF and AoA (sagittal) were found to be the greatest at the anterior genu of the ICA. CONCLUSIONS ETON is feasible. It provides wide exposure of the skull base and proximal control of the ICA. It may be indicated for the management of nasopharyngeal tumors with inferolateral extension, involving the ICA.
Collapse
Affiliation(s)
- Roberto M Soriano
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rima S Rindler
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samuel N Helman
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Yacoub A, Schneider D, Ali A, Wimmer W, Caversaccio M, Anschuetz L. Endoscopic-Assisted Lateral Corridor to the Infratemporal Fossa: Proposal and Quantitative Comparison to the Endoscopic Transpterygoid Approach. J Neurol Surg B Skull Base 2019; 82:357-364. [PMID: 34026413 DOI: 10.1055/s-0039-3399553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022] Open
Abstract
Objective This study was aimed to propose an expanded endoscopic-assisted lateral approach to the infratemporal fossa (ITF) and compare its area of exposure and surgical freedom with the endoscopic endonasal transptergyoid approach (EETA). Methods Anatomical dissections were performed in five cadaver heads (10 sides). The ITF was first examined through the endoscopically assisted lateral corridor, herein referred to as the endoscopic-assisted transtemporal fossa approach (TTFA). After that, the EETA was performed and coupled with two sequential maxillary procedures (medial maxillectomy [MM], and endoscopic-assisted Denker's approach [DA]). Using the stereotactic neuronavigation, measurements of the area of exposure and surgical freedom at the foramen ovale were determined for the previously mentioned approaches. Results Bimanual exploration of the ITF through the endoscopic-assisted lateral approach was achieved in all specimens. The DA (729 ± 49 mm 2 ) provided a larger area of exposure than MM (568 ± 46 mm 2 ; p < 0.0001). However, areas of exposure were similar between the DA and the TTFA (677 ± 35 mm 2 ; p = 0.09). The surgical freedom offered by the TTFA (109.3 ± 19 cm 2 ) was much greater than the DA (24.7 ± 4.8 cm 2 ; p < 0.0001), and the MM (15.2 ± 3.2 cm 2 , p < 0.0001). Conclusion The study demonstrates the feasibility of the proposed approach to provide direct access to the extreme extensions of the ITF. The lateral corridor offers an ideal working area in the posterior compartment of the ITF without crossing over important neurovascular structures. The new technique may be used alone in selected primary ITF lesions or in combination with endonasal approaches in pathologies spreading laterally from the nose or nasopharynx.
Collapse
Affiliation(s)
- Abraam Yacoub
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland.,Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Daniel Schneider
- Image-Guided Therapy, ARTORG Center for Biomedical Research, University of Bern, Switzerland
| | - Ahmed Ali
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland
| |
Collapse
|
9
|
Cai WW, Zou Y, Kang Z, Liang JG, He HY, Yang QT. Endoscopic anatomical study of the trans-lateral molar approach to the infratemporal fossa. Eur Arch Otorhinolaryngol 2019; 276:1783-1791. [DOI: 10.1007/s00405-019-05409-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
|
10
|
Torres-Gaya J, Puche-Torres M, Marqués-Mateo M, García Callejo FJ. Transoral (transvestibular-paramandibular) endoscopic approach for benign tumours in the infratemporal fossa. BMJ Case Rep 2019; 12:12/1/bcr-2018-227169. [PMID: 30642859 DOI: 10.1136/bcr-2018-227169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a minimally invasive transoral approach to the infratemporal fossa, by means of endoscopy, which facilitates examination and resection of lesions in this area. Furthermore, we outline the technique employed and a case treated with this approach, which permits a rapid access with very low patient morbidity, due to the use of endoscopy and of transoral access, instead of traditional transfacial approaches.
Collapse
Affiliation(s)
- Jorge Torres-Gaya
- Maxillofacial Department, Hospital Clinico Universitario, Valencia, Spain
| | - Miguel Puche-Torres
- Maxillofacial Department, Hospital Clinico Universitario, Valencia, Spain.,Surgery Department, INCLIVA, Universitat de Valencia Facultat de Medicina i Odontologia, Valencia, Spain
| | - Mariano Marqués-Mateo
- Maxillofacial Department, Hospital Clinico Universitario, Valencia, Spain.,Surgery Department, Universitat de Valencia Facultat de Medicina i Odontologia, Valencia, Spain
| | | |
Collapse
|