Konuthula Neeraja, Abuzeid Waleed M, Humphreys Ian M, Bly Randall A, Moe Kris
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, United States.
Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, United States.
J Neurol Surg B Skull Base. 2021 Aug 18;83(Suppl 2):e514-e520. doi: 10.1055/s-0041-1733919. eCollection 2022 Jun.
Several different open and endoscopic approaches for the pterygomaxillary space and infratemporal fossa have been described. Limitations to these approaches include restricted exposure of the infratemporal fossa and difficult surgical manipulation. Consecutive clinical cases utilizing a novel approach to access lesions in the infratemporal fossa and pterygomaxillary space were reviewed. Data was collected on pathology, lesion location, and surgical approach(es) performed. Computer modeling was performed to analyze the full extent of surgical access provided by the paramaxillary approach to the range of target locations. Ten consecutive cases met inclusion criteria. Surgical access to the target lesion was achieved in all cases. Computer modeling of the approach derived the anatomical boundaries of the paramaxillary approach. Wide access to the posterior maxilla, and lateral or medial to the mandibular condyle allows for variability in endoscopic angles and access to more medial pterygomaxillary space lesions. The lateral extent is limited proximally only by the extent of cheek/soft tissue retraction and by the zygomatic arch more superiorly. The superior limit of dissection is at the temporal line. The endoscopic paramaxillary approach is a transoral minimally disruptive approach to the ITF and PS that provides excellent surgical exposure for resection of lesions involving these areas. Compared with previously described endoscopic approaches, there are no external incisions; tumor manipulation is straightforward without angled endoscopy, and all areas of the infratemporal fossa and pterygomaxillary space can be accessed.
针对翼上颌间隙和颞下窝，已经描述了几种不同的开放手术和内镜手术入路。这些入路的局限性包括颞下窝暴露受限以及手术操作困难。回顾了一系列采用新型入路来处理颞下窝和翼上颌间隙病变的临床病例。收集了有关病理、病变位置以及所采用手术入路的数据。进行了计算机建模，以分析经上颌旁入路对一系列目标位置所能提供的手术暴露范围。连续10例病例符合纳入标准。所有病例均实现了对目标病变的手术暴露。该入路的计算机建模得出了上颌旁入路的解剖边界。对上颌后部以及下颌髁突外侧或内侧的广泛暴露，使得内镜角度具有可变性，并且能够处理翼上颌间隙更内侧的病变。外侧范围在近端仅受脸颊/软组织牵拉程度以及上方颧弓的限制。解剖的上限位于颞线。内镜上颌旁入路是一种经口的微创入路，用于处理颞下窝和翼上颌间隙，为切除累及这些区域的病变提供了良好的手术暴露。与先前描述的内镜入路相比，该入路无外部切口；无需使用角度内镜即可直接操作肿瘤，并且可以进入颞下窝和翼上颌间隙的所有区域。
