Advertisement

Endoscopic transvestibular anatomy of the infratemporal fossa and upper parapharyngeal spaces for clinical surgery: a cadaver study

  • Yi Fang
  • Haitao Wu
  • Weidong Zhao
  • Lei ChengEmail author
Head & Neck
  • 21 Downloads

Abstract

Aims

To investigate the anatomy of the infratemporal fossa (ITF) and to discuss the practicality of endoscopic transvestibular surgery for an ITF tumor.

Methods

Five fresh cadaveric specimens (10 sides) with vascular silicone injection were prepared for endoscopic anatomy. A transvestibular vertical incision was made along the ramus of the mandible, and pivotal nerves, arteries, and muscles were exposed to sculpt the anatomic landmarks of the ITF.

Results

The endoscopic transvestibular approach exposed the detailed structure of the ITF. The buccinator muscle and the adjoining superior pharyngeal constrictor muscle shaped the paramedian border of the ITF, while the medial pterygoid muscle (MPM) and the lateral pterygoid muscle formed the lateral border. The ITF was delimited by the skull base in the upper margin, and it was proximal to the parapharyngeal space in the inferior part. The inferior alveolar nerve was the first reference point, and the maxillary artery and the lateral pterygoid muscle were also the landmarks of the ITF. The lingual nerve, the eustachian tube (ET), and the middle meningeal artery were also located in the posterior part of the ITF.

Conclusion

The endoscopic transvestibular approach provides a feasible and facile corridor to the ITF. With accurate hemostasis, this approach may provide another option for accessing the ITF for removal of tumors.

Keywords

Anatomy Regional Video-assisted surgery Infratemporal fossa Surgical oncology 

Abbreviations

ITF

Infratemporal fossa

SPCM

Superior pharyngeal constrictor muscle

MPM

Medial pterygoid muscle

LPM

Lateral pterygoid muscle

PPS

Parapharyngeal space

ICA

Internal carotid artery

IJV

Internal jugular vein

MCP

Mandibular coronoid process

IAN

Inferior alveolar nerve

PMR

Pterygomandibular raphe

MMA

Middle meningeal artery

ET

Eustachian tube

TMJ

Temporomandibular joint

Notes

Acknowledgments

We are very grateful to Deng Wenyao and Hu Chen for their selfless assistance and admirable work during the anatomic project.

Funding

This research is supported by the Scientific Research Project of Science and Technology Commission of Shanghai Municipality (Project Number: 16411960600).

Compliance with ethical standards

Conflict of interest

There is no financial relationship and conflict of interest among all authors.

References

  1. 1.
    Conley JJ (1956) The surgical approach to the pterygoid area. Ann Surg 144(1):39–43CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Barbosa JF (1961) Surgery of extensive cancer of paranasal sinuses. Presentation of a new technique. Arch Otolaryngol (Chicago, Ill.: 1960) 73:129–138CrossRefGoogle Scholar
  3. 3.
    Guo Y, Guo C (2014) Maxillary-fronto-temporal approach for removal of recurrent malignant infratemporal fossa tumors: anatomical and clinical study. J Cranio-Maxillo-Facial Surg 42(3):206–212CrossRefGoogle Scholar
  4. 4.
    Fisch U (1978) Infratemporal fossa approach of tumors of the temporal bone and base skull. J Laryngol Otol 92(11):949–967CrossRefGoogle Scholar
  5. 5.
    Fisch U (1982) Infratemporal fossa approach for glomus tumors of the temporal bone. Ann Otol Rhinol Laryngol 91(5):474–479CrossRefGoogle Scholar
  6. 6.
    Mickey B, Close L, Schaefer S, Samson D (1988) A combined frontotemporal and lateral infratemporal fossa approach to the skull base. J Neurosurg 68(5):678–683CrossRefGoogle Scholar
  7. 7.
    Oakley GM, Harvey RJ (2017) Endoscopic resection of pterygopalatine fossa and infratemporal fossa malignancies. Otolaryngol Clin N Am 50(2):301–313CrossRefGoogle Scholar
  8. 8.
    He H, Yang Q, Gong J et al (2018) Endoscopic transvestibular transmandibular approach for trigeminal schwannoma in infratemporal fossa and parapharyngeal space. World Neurosurg 118:172–176CrossRefGoogle Scholar
  9. 9.
    Dallan I, Fiacchini G, Turri-Zanoni M et al (2016) Endoscopic-assisted transoral-transpharyngeal approach to parapharyngeal space and infratemporal fossa: focus on feasibility and lessons learned. Eur Arch Otorhinolaryngol 273(11):3965–3972CrossRefGoogle Scholar
  10. 10.
    Chan JYK, Li RJ, Lim M, Hinojosa AQ, Boahene KD (2011) Endoscopic transvestibular paramandibular exploration of the infratemporal fossa and parapharyngeal space: a minimally invasive approach to the middle cranial base. Laryngoscope 121(10):2075–2080CrossRefGoogle Scholar
  11. 11.
    Torres-Gaya J, Puche-Torres M, Marques-Mateo M, Garcia Callejo FJ (2019) Transoral (transvestibular-paramandibular) endoscopic approach for benign tumours in the infratemporal fossa. BMJ Case Rep 12:1Google Scholar
  12. 12.
    Allen WE 3rd, Kier EL, Rothman SL (1973) The maxillary artery: normal arteriographic anatomy. Am J Roentgenol Radium Ther Nucl Med 118(3):517–527CrossRefGoogle Scholar
  13. 13.
    Turri-Zanoni M, Battaglia P, Dallan I, Locatelli D, Castelnuovo P (2016) Multiportal combined transnasal transoral transpharyngeal endoscopic approach for selected skull base cancers. Head Neck 38(6):E2440–e2445CrossRefGoogle Scholar
  14. 14.
    Battaglia P, Turri-Zanoni M, Dallan I et al (2014) Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors. Otolaryngology Head Neck Surg. 150(4):696–702CrossRefGoogle Scholar
  15. 15.
    Kuet ML, Kasbekar AV, Masterson L, Jani P (2015) Management of tumors arising from the Parapharyngeal space: a systematic review of 1,293 cases reported over 25 years. Laryngoscope 125(6):1372–1381CrossRefGoogle Scholar
  16. 16.
    Nakaya M, Kida W, Ito A, Yoshihara S, Fuchigami T (2015) Endoscopic transoral and transmaxillary excision of the infratemporal fossa hemangioma. Auris Nasus Larynx 42(3):258–262CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat HospitalFudan UniversityShanghaiChina

Personalised recommendations