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Clinical implications of transpterygoid approach to mandibular nerve

Abstract

Background

The endonasal transpterygoid approach has been very popular as a standard approach to the pterygopalatine and infratemporal fossa. However, its implications actually extend beyond these regions to include access to the middle cranial fossa and parapharyngeal space.

Objective

The aim was to illustrate the anatomical landmarks of the endoscopic transpterygoid approach especially the mandibular nerve and clinical implication of this approach through illustrated case presentation.

Materials and methods

A cadaveric study was performed on three cadaveric adult specimens. Endoscopic medial maxillectomy, Sturman Canefield approach, and completion of transpterygoid approach were done to visualize the different anatomical landmarks, especially the mandibular nerve. An example of clinical application of transpterygoid approach is an illustrated case to biopsy a perineural spread of squamous cell cancer along the mandibular nerve in the lateral wall of cavernous sinus.

Conclusion

Endoscopic transpterygoid approach is very useful to resect most of benign and some malignant tumors that involve the infratemporal fossa and middle cranial fossa. Good understanding of the V3 anatomy helps in the resection of tumors extending to the infratemporal fossa and poststyloid parapharyngeal space.

References

  1. 1

    Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19:E6.

    PubMed  Google Scholar 

  2. 2

    Fortes FS, Sennes LU, Carrau RL, et al. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model. Laryngoscope 2008; 118:44–49.

    Article  Google Scholar 

  3. 3

    Kassam AB, Prevedello DM, Carrau RL, et al. The front door to Meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach – technical considerations and clinical series. Neurosurgery 2009; 64:71–82.

    Google Scholar 

  4. 4

    Zanation AM, Snyderman CH, Carrau RL, et al. Endoscopic endonasal surgery for petrous apex lesions. Laryngoscope 2009; 119:19–25.

    Article  Google Scholar 

  5. 5

    Mousa Sadr Hosseini S, Razfar A, Carrau RL, et al. Endonasal transpterygoid approach to the infratemporal fossa: correlation of endoscopic and multiplanar CT anatomy. Head Neck 2012; 34:313–320.

    Article  Google Scholar 

  6. 6

    Vilela MD, Rostomily RC. Temporomandibular joint-preserving preauricular subtemporal-infratemporal fossa approach: surgical technique and clinical application. Neurosurgery 2004; 55:143–153; discussion 153–154.

    Article  Google Scholar 

  7. 7

    Kasemsiri P, Solares CA, Carrau RL, et al. Endoscopic endonasal transpterygoid approaches: anatomical landmarks for planning the surgical corridor. Laryngoscope 2013; 123:811–815.

    Article  Google Scholar 

  8. 8

    Vescan AD, Snyderman CH, Carrau RL, et al. Vidian canal: analysis and relationship to the internal carotid artery. Laryngoscope 2007; 117:1338–1342.

    Article  Google Scholar 

  9. 9

    Kassam AB, Vescan AD, Carrau RL, et al. Expanded endonasal approach: Vidian canal as a landmark to the petrous internal carotid artery. J Neurosurg 2008; 108:177–183.

    Article  Google Scholar 

  10. 10

    Dallan I, Lenzi R, Bignami M, Battaglia P, Sellari-Franceschini S, Muscatello L, et al. Endoscopic transnasal anatomy of the infratemporal fossa and upper parapharyngeal regions: correlations with traditional perspectives and surgical implications. Minim Invasive Neurosurg 2010; 53:261–269.

    CAS  Article  Google Scholar 

Download references

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Correspondence to Ahmed Youssef MD, PhD, MRCS.

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Youssef, A., Carrau, R.L., Ahmed, S. et al. Clinical implications of transpterygoid approach to mandibular nerve. Egypt J Otolaryngol 34, 278–282 (2018). https://doi.org/10.4103/ejo.ejo_30_18

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Keywords

  • infratemporal fossa
  • internal carotid artery
  • transpterygoid approach
  • V2
  • V3