Anterior hypotympanic approach for glomus tumor of the infratemporal fossa.

The anterior hypotympanic approach to the infratemporal fossa permits direct exposure of glomus jugulare and glomus tympanicum tumors of the middle ear, hypotympanum and petrous apex with the preservation of normal structures and hearing. Smaller glomus tumors arising in the middle ear extend anteriorly along the paths of least resistance into the hypotympanum and petrous apex to involve the carotid canal and, only later in the course of disease, extensively involve the jugular bulb, neck, or mastoid air cell system. Clinical experience demonstrates that this approach can effectively cure or control small glomus tumors in selected patients. In patients with more extensive disease, the surgical field may be expanded by removing the mastoid tip with facial nerve mobilization to remove the jugular bulb and posterior tumor extensions while preserving middle ear function and hearing.