Georgia Skull Base Center, Department of Otolaryngology, Medical College of Georgia at Georgia Regents University, Augusta, Georgia.
Laryngoscope. 2013 Oct;123(10):2378-82. doi: 10.1002/lary.24121. Epub 2013 May 17.
OBJECTIVES/HYPOTHESIS: A subtemporal preauricular approach to the infratemporal fossa and parapharyngeal space has been the traditional path to tumors of this region. The morbidity associated with this procedure has lead to the pursuit of less invasive techniques. Endoscopic access using a minimally invasive transmaxillary/transpterygoid approach potentially may obviate the drawbacks associated with open surgery. The anatomy of the parapharyngeal space is complex and critical; therefore, a comparison of the anatomy exposed by these different approaches could aid in the decision making toward a minimally invasive surgical corridor.
Technical Note.
The parapharyngeal space was accessed endonasally by removal of the medial and posterior walls of the maxillary sinus. To allow better visualization and increased triangulation of a bimanual dissection technique, a sublabial canine fossa antrostomy was created. The medial and lateral pterygoid plates were removed. Further lateral dissection exposed the relevant anatomy of the parapharyngeal space. A subtemporal preauricular infratemporal approach was also completed.
The endoscopic approach provided sufficient access to the superior portion of the parapharyngeal space. The open approach also provided adequate access; however, it required a larger surgical window, causing greater injury. A significant advantage of the subtemporal approach is the improved access to the petrous portion of the internal carotid artery. Conversely, the endonasal approach provided improved access to the anterior and medial portions of the superior parapharyngeal space.
Endoscopic endonasal access utilizing a transmaxillary/transpterygoid approach provides a sufficient surgical window for tumor extirpation. Utilization of this approach obviates some of the morbidity associated with an open procedure.
目的/假设：经颞下耳前入路进入颞下窝和咽旁间隙一直是该区域肿瘤的传统路径。与该手术相关的发病率导致人们寻求创伤更小的技术。使用经微创经上颌/经翼突入路的内镜进入可能避免与开放手术相关的缺点。咽旁间隙的解剖结构复杂且关键；因此，对这些不同入路所暴露的解剖结构进行比较，可以帮助做出选择微创手术通道的决策。
技术说明。
通过去除上颌窦的内侧壁和后壁，经鼻内进入咽旁间隙。为了更好地可视化和增加双手解剖技术的三角测量，创建了一个唇下犬齿窝上颌窦切开术。切除了内侧和外侧翼突板。进一步的外侧解剖暴露了咽旁间隙的相关解剖结构。还完成了经颞下耳前颞下窝入路。
内镜入路提供了足够的进入咽旁间隙上部的通道。开放入路也提供了足够的通道；然而，它需要更大的手术窗口，造成更大的损伤。颞下入路的一个显著优势是改善了对颈内动脉岩骨段的进入。相反，经鼻入路提供了对咽旁间隙上部前内侧部分的更好进入。
利用经上颌/经翼突入路的内镜经鼻入路为肿瘤切除提供了足够的手术窗口。利用这种方法避免了一些与开放手术相关的发病率。
5 级。
