An infratemporal fossa approach for extensive tumors of the temporal bone, clivus, and parasellar and parasphenoid regions features permanent anterior transposition of the facial nerve, resection of the mandibular condyle, and mobilization of the. Infratemporal fossa an overview sciencedirect topics. Infratemporal fossa approach request pdf researchgate. Surgical management of tumors involving the infratemporal fossa can be technically challenging. The parapharyngeal space is a potential space that presents a formidable challenge to the surgeon. The approach features the permanent anterior transposition of the facial nerve, resection of the mandibular condyle and mobilization of the zygoma and lateral orbital rim. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach. Retrieving a displaced third molar from the infratemporal.
The middle fossa approach is best suited for lesions situated lateral within the iac that have limited extension into the cpa less than 1 cm and where hearing preservation is the goal. Endoscopic transnasal approach to the pterygopalatine fossa. Microanatomy and surgical approaches to the infratemporal fossa. Management of advanced intracranial intradural juvenile nasopharyngeal angiofibroma. This approach allows exposure to the infratemporal fossa medial to the pterygoid plate but only gives a limited view of the lateral regions. The fisch infratemporal fossa approach thieme connect. The occipital bones, including, temporal bone, sphenoid bone, parietal bone and the frontal bone put up to its concave wall. An infratemporal fossa approach is a complex procedure that involves significant time, effort, and cost. Pdf preauricular infratemporal fossa surgical approach. Download pdf 925k surgical strategy for tumors located in or extending from the intracranial space to the infratemporal fossa advantages of the transcranial approach zygomatic infratemporal fossa approach and the indications for a combined transcranial and transcervical approach.
Caldwellluc, graceys curette, inadvertent injuries, infratemporal fossa, maxillary sinus. It is superior to the infratemporal fossa and terminating beneath the level of the zygomatic arch. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Tumors not involving the petrous apex or the carotid artery can.
A retrospective clinical analysis was performed to evaluate the effectiveness of the preauricular infratemporal fossa itf surgical approach using modifications based on tumor pathology and extension, without compromising outcomes. The infratemporal fossa is a wellguarded area of the skull base. Godil md 1, 3, iyan younus bs 4, michael rezk md 5 and theodore h. Infratemporal fossa approach to lesions in the temporal. Space occupying lesions of the skull base are in the borderland of several disciplines.
The infratemporal fossa approach for nasopharyngeal tumors. Preauricular transzygomatic approach for infratemporal fossa and. A lateral transzygomatictranstemporal approach to the. This approach is divided into three exposures, types a, b, and c, depending on the amount of anterior exposure required. The close anatomic relation between maxillary molars, maxillary sinus, and infratemporal fossa calls for a meticulous clinical and radiological examination before any treatment to prevent inadvertent injuries. Choose from 500 different sets of infratemporal fossa flashcards on quizlet. The aims of this study were to demonstrate the surgical technique involved in the preauricular infratemporal fossa itf approach, outline the clinical indications for use of this technique, and present the results in using this approach in 159 patients with malignant parotid tumors. Its limits are represented anteriorly by the maxillary tuberosity and the maxillary sinus, superiorly by the greater wing of the sphenoid bone and part of the temporal bone, medially by the lateral plate of the pterygoid process and the lateral wall of the pharynx. Preauricular infratemporal fossa approach for advanced.
The infratemporal fossa approach provides a direct surgical access to the entire length of the lateral skull base, from the nasopharyngeal and parapharyngeal space anteriorly to the foramen jugulare posteriorly. It is not fully enclosed by bone in all directions, and it contains superficial muscles that are visible during dissection after removing skin and fascia. Each of these approaches is effective in exposing lesions of the infratemporal fossa but carries the risk of cranial nerve morbidity and extensive softtissue disruption. The infratemporal fossa is the space between the skull base, lateral pharyngeal wall, and the ramus of mandible the fossa is actually open to the neck posteroinferiorly and in doing so has no true anatomical floor. Pdf endoscopic anatomy of the pterygopalatine fossa and. The infratemporal fossa is a complex space of the face that lies posterolateral to the maxillary sinus and many important nerves and vessels traverse it gross anatomy. To describe a less invasive transcranial extradural approach to itf parapharyngeal lesions and to determine its advantages, 17 patients with itf parapharyngeal neoplasms who underwent tumor resection via infgatemporal approach were enrolled in the study. The tumor invades the infratemporal fossa or orbit without intracranial involvement. The tumour extended from the posterior cranial fossa and involved meckels cave and the lateral wall of the cavernous sinus in each instance. Wed like to understand how you use our websites in order to improve them. Carrau b, ahmed tantawy a, ahmed aly ibrahim a a department of otolaryngologyhead and neck surgery, alexandria university, egypt b department of otolaryngologyhead and neck surgery, ohio state university wexner medical center, usa received 30 august 20.
Very little has been written on the regional anatomy of the hypoglossal canal as seen through a transtemporal approach. The infratemporal fossa itf is a deep quadrangular space inferior to the base of the middle cranial fossa. The infratemporal fossa type a approach allows safe access to the infralabyrinthine temporal bone, petrous apex, mandibular fossa, and posterior infratemporal fossa. Tumors arising from or extending into the itf from neighboring regions provide a challenge as to how best to approach the area tumors within the itf are rare, making up less than 1% of head and neck tumors the itf approaches are categorized as anterior transfacial, transmaxillary, transoral, and transpalatal, lateral transzygomatic and lateral infratemporal. Yet more aggressive bony resection along the horizontal segment of the petrous ica exposes the preclival region and sphenoid sinus. The infratemporal fossa is a complex area located at the base of the skull, deep to the masseter muscle it is closely associated with both the temporal and pterygopalatine fossae and acts as a conduit for neurovascular structures entering and leaving the cranial cavity this article will outline the borders and content of the fossa before examining its clinical relevance. Endoscopic versus open approach to the infratemporal fossa. We describe a minimally invasive transoral approach to the infratemporal fossa, by means of endoscopy, which facilitates examination and resection of lesions in this area. If residual tumor has to be left back in the cavernous sinus, irradiation is used. It is a combination craniotemporalcervical approach and requires anterior transposition of the facial nerve. The approach to the infratemporal fossa requires a medial maxillectomy with the option of removing the lateral wall of the inferior meatus and the pyriform aperture endoscopic denker. Furthermore, we outline the technique employed and a case treated with this approach, which permits a rapid access with very low patient morbidity, due to the use of endoscopy and of transoral access, instead of traditional. Infratemporal fossa approach for extensive tumors of the temporal bone and base of the skull.
Combined infratemporal fossa and transfacial approach to. Infratemporal fossa approach to lesions in the temporal bone and base of the skull. The infratemporal fossa approach for lesions of the skull base. Blood loss, which was ml in a nonembolized patient, was reduced to ml in embolized patients 31 32 tumors that further extend into the infratemporal fossa may progress into the orbit, through the inferior orbital fissure and to the base of the skull. Endoscopic approach to the infratemporal fossa sciencedirect. Infratemporal fossa approaches linkedin slideshare.
Because these lesions arise in an area which has hitherto been. A posterior septectomy or a septotomy located approximately 1. Multiportal and multicorridor access provides significant surgical freedom while avoiding instrument collision. The numerous retrieval techniques reported are invasive and provide an unpredictable access. The infratemporal fossa itf is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Infratemporal fossa approach for glomus tumors of the. Infratemporal fossa approach to tumours of the temporal bone and base of the skull. Traditional approaches to these lesions include the preauricular infratemporal approach, a transmandibular approach, and a fisch type c approach.
The accidental displacement of a maxillary third molar in the infratemporal fossa itf, is a rare complication that can occur even with experienced surgeons. The infratemporal fossa borders contents teachmeanatomy. The infratemporal fossa approach to the lateral skull base and. The combined infratemporal and posterior fossa approach was used in two specimens, the subtemporal preauricular itf approach in another two, the zygomatic. Depending on the location of the lesion any of four approaches may be used. Both lateral approaches have the potential for csf leakage.
Transoral transvestibularparamandibular endoscopic. Middle infratemporal fossa less invasive approach infratemporzl radical resection of parapharyngeal tumors. The facial nerve is rerouted anteriorly to provide direct access to the jugular foramen and adjacent skull base. Endoscopic approaches are more appropriate than conventional approaches if the goal is palliation. To evaluate the role of lateral skull base approaches in the management of benign parapharyngeal space tumors and to propose an algorithm for their surgical approach. Mobilization of the facial nerve allows seamless exposure of the intra and extratemporal internal carotid artery. Thus, early diagnosis, accurate staging, and adequate treatment are essential in the management of this lesion. The temporal fossa is a shallow depression on the temporal lines and one of the be massive marks on the skull. The endoscopic endonasal approach provides an alternative to open surgical approaches and may obviate the need for facial nerve transposition, middle ear obliteration, and brain retraction.
Many surgical approaches have been used for the retrieval surgery of displaced maxillary third molar into the infratemporal fossa area such as long incision in the buccal sulcus, gilliess approach, the caldwellluc approach through the maxillary sinus after removal of the whole posterior wall, and resection of the coronoid process, 6. Principally four approaches were used in this study. Infratemporal fossa approach to tumours of the temporal. The type c approach is an anterior extension of the type b approach. The infratemporal fossa is a deeply situated region that can give rise to a range of benign and malignant tumors. Pdf background the infratemporal fossa itf is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the. The infratemporal fossa is an irregularly shaped cavity, situated below and medial to the zygomatic arch.
This project attempts to further define the anatomy of the hypoglossal canal and provide the surgeon. The infratemporal fossa approach was designed to provide access to the skull base for resection of large glomus tumors and other lesions of the jugular foramen area. In summary, the combined endoscopic endonasal and sublabial transmaxillary approach is a versatile approach for giant infratemporal fossa tumors with lateral extension. The expanded endonasal approach is a feasible approach to the middle third of the clivus, petrous ica, cavernous sinus, and medial infratemporal fossa in cases in which the lesion is located. This allows the removal ofmassive tumors ofthe area without the necessity ofresorting to the type c approach and the resultant loss ofhearing and the possibility of facial paralysis.
The aims of this study were to demonstrate the surgical technique involved in the preauricular infratemporal fossa itf approach, outline the clinical indications for use of this technique, and. A small craniectomy in the infratemporal fossa incorporating the foramen ovale was used to resect 4 large trigeminal neurinomas. Due to its difficult approach, surgical intervention at the itf has remained a heavy burden to surgeons. The infratemporal fossa approach closes the existing gap in the surgical management of the most hidden lesions of the temporal bone. The lateral approach may be either transzygomatic or transmandibular. The infratemporal fossa approach, developed by fisch 106 in 1977, is a craniotemporocervical approach for exposure of the lateral inferior skull base. The subtemporal and infratemporal approach as modified by sekhar et al. The approach used for the ppf biopsy in 2 patients in our series cases 2 and 3 first identifies the sphenopalatine foramen medially, similar to the. Infratemporal fossa interdural approach for trigeminal. The authors describe approaching the tumor directly through the posterior wall of the maxillary sinus, which may be better for more laterally positioned tumors in the ppf or infratemporal fossa. Learn infratemporal fossa with free interactive flashcards. You can find your own infratemporal fossa by clenching your jaw and feeling for the ridge of the masseter muscle in your cheek.
Microsurgical anatomy of the infratemporal fossa as viewed. Combined endoscopic endonasal and sublabial transmaxillary. Request pdf infratemporal fossa approach the infratemporal fossa is a relatively simple area of anatomy located centrally among a number of adjacent. Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space. Transtemporal approaches to posterior cranial fossa. Internal carotid aneurysms at the base of the skull after blunt trauma are infrequent but their management is difficult, leading many. Infratemporal fossa approach to tumours of the temporal bone and base of the skull volume 92 issue 11 u. Subtemporalpreauricular infratemporal fossa approach to large. Extension of the medial maxillectomy anteriorly was done to reach the lateral part of the infratemporal fossa. The appropriate management of postoperative complication of wisdom teeth removal is of utmost importance as it can result in legal procedures. Infratemporal fossa approach to the hypoglossal canal. Infratemporal fossa fat enlargement in chronic maxillary atelectasis.
Endoscopic transorbital approach to the infratemporal. Various modifications in this approach can be used to. Pdf infratemporal fossa approach to tumours of the. Endoscopic approach to the infratemporal fossa ahmed youssef a, ricardo l. Wgs represents an efficient tool for monitoring kluyvera spp.
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