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Dwivedi G, Gupta V, Tiwari V, Patnaik U, Sood A, Kumari A, Bharadwaja S. Different Approaches to the Overlapping Infratemporal Fossa and Parapharyngeal Spaces: a Case Series and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:2337-2343. [PMID: 36452571 PMCID: PMC9702234 DOI: 10.1007/s12070-020-02168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Parapharyngeal space and infratemporal fossa are 2 overlapping spaces in head and neck which have complex anatomy with vital neurovascular structures passing through them. Tumors of this region are extremely rare but majority of them (80%) are benign. Benign tumors of this region can lead to swellings in facial region, neck and oropharynx. Dysphagia may be a complaint of the patient. Many of these tumors have malignant potential. Removal of these tumors requires a good understanding of the anatomy of this space so that correct surgical approach can be selected. The surgeon needs to be adept in using the most suitable surgical approach for excision of these tumors. There are various approaches which can be used to access these deeply seated tumors but the issue of prime importance is selecting the appropriate approach for the various tumors here based on their size and their exact location in this complex anatomical space. Inappropriate approach can lead to inadequate tumor excision and can lead to injuries to the neurovascular structures in this region which can cause significant disability. The case series reported here describes the various approaches to this region and highlights the importance of correct selection of the surgical approach.
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Affiliation(s)
| | | | | | | | - Amit Sood
- Department of ENT, CHSC, AFMC, Pune, India
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Turner MT, Topf MC, Holsinger FC, Chan JYK. Robotic transmaxillary approach to the lateral infratemporal fossa: A preclinical cadaveric study using a next-generation single-port robotic system. Head Neck 2021; 43:1964-1970. [PMID: 33764626 DOI: 10.1002/hed.26680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/07/2022] Open
Abstract
Robotic transmaxillary skull base surgery has been described using multiport systems. This cadaveric study investigates the feasibility of transmaxillary skull base surgery using a next-generation robot. An extended Caldwell-Luc antrostomy, measuring 3.3 cm by 4.0 cm, was performed in 15 min using a Kerrison rongeur and the robotic endoscope. A single-port, robotic system (da Vinci Sp®, Intuitive Surgical, Inc, Sunnyvale, CA, USA) was then deployed throught the extended Caldwell-Luc approach and provided sufficient reach, visualization, and maneuverability to work within the pterygopalatine fossa (PPF) and the infratemporal fossa (ITF) using three surgical instruments. The ITF dissection was easiest with two instruments using the third instrument to retract the muscles of mastication. This study demonstrates the feasibility of single-port robotic transmaxillary approaches to the lateral ITF. Using a single-port robotic system, the operating surgeon can for the first time work in the PPF and ITF using two functional arms for tumor dissection and a third to retract.
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Affiliation(s)
- Meghan T Turner
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Jason Y-K Chan
- Department of Otorhinolaryngology, Chinese University of Hong Kong, Hong Kong, China
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Xie L, Huang W, Wang J, Zhou Y, Chen J, Chen X. Modified Maxillary-Swing Approach for Resection of Primary Malignancies in the Pterygopalatine Fossa. Front Oncol 2020; 10:530381. [PMID: 33240804 PMCID: PMC7682189 DOI: 10.3389/fonc.2020.530381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background En bloc resection of malignancies in the pterygopalatine fossa (PPF) poses critical challenges. Using the modified maxillary-swing (MMS) approach, we achieved monobloc removal of primary malignancies in this region. This study provides a detailed account of the surgical techniques and indications used. Methods We enrolled seven patients with primary malignancies in the PPF during a period from January 2012 to January 2019 in this retrospective study. After malignancies were confirmed by biopsy as well as evaluation with computed tomography (CT) and magnetic resonance imaging (MRI) scans, all of the patients underwent MMS surgery under general anesthesia to extirpate these tumors. We performed regular postoperative follow-up using CT and MRI scans. Results En bloc resection was successfully performed in all cases. We observed negative margins in six cases and positive margins in one patient with adenoid cystic carcinoma, who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range, 6-69 months), one patient suffered from recurrence, while the others did not. Conclusion The advantages of the MMS include a wide surgical field, full exposure, and easy manipulation. We expect this approach to become an alternative to the monobloc resection of malignancies in the PPF that involve the infratemporal fossa, maxillary sinus, nasal cavity, orbit, or oral cavity.
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Affiliation(s)
- Li Xie
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Wenxiao Huang
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Junqi Wang
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Yue Zhou
- Department of Radiation Oncology, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Jie Chen
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Xue Chen
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
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Li DF, Shi L, Wang J, Yue B, Ding ZJ, Chen FQ. Endoscopic Trans-Lateral Molar Approach to Infratemporal Fossa Lesions. EAR, NOSE & THROAT JOURNAL 2020; 100:1017S-1022S. [PMID: 32538672 DOI: 10.1177/0145561320934593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To study the endoscopic trans-lateral molar (ETLM) approach to infratemporal fossa (ITF) lesions and analyze the advantages and disadvantages of this method. METHODS Four cases of ITF lesions were analyzed retrospectively. The clinical features, diagnosis and treatments, the operative process, and clinical applications of this surgical approach were discussed. RESULTS Postoperative pathologies were 2 pleomorphic adenomas, 1 schwannoma, and 1 inflammatory lesion. All patients had self-resolving cheek swelling and pharyngalgia in the short term, but 2 patients had numbness in the long term. There was no infection or bleeding in the postoperative period, and no difficulty in chewing after disease recovery. There was no tumor recurrence during the follow-up period. CONCLUSION The ETLM approach is convenient, minimally invasive, and allows complete excision of benign ITF lesions, posterior to the lateral pterygoid muscle and mainly below the level of the hard palate. It is a simple and direct access to the ITF, but it is a narrow access because of the limitations of bones and soft tissues. Appropriate patient selection is mandatory for successful surgery.
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Affiliation(s)
- Dan-Feng Li
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Li Shi
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jian Wang
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Bo Yue
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Zhong-Jia Ding
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Fu-Quan Chen
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Successful management of recurrent adenoid cystic carcinoma in the deep infratemporal fossa by maxillo-orbito-zygomatic approach. Auris Nasus Larynx 2019; 46:921-926. [DOI: 10.1016/j.anl.2018.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 11/23/2022]
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Schlund M, Depeyre A, Raoul G, Nicot R. Zygomatic swing approach to the infratemporal fossa. Br J Oral Maxillofac Surg 2019; 57:600-602. [DOI: 10.1016/j.bjoms.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
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Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa. J Craniofac Surg 2019; 30:589-595. [DOI: 10.1097/scs.0000000000005108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Roger V, Patron V, Moreau S, Kanagalingam J, Babin E, Hitier M. Extended endonasal approach versus maxillary swing approach to the parapharyngeal space. Head Neck 2018; 40:1120-1130. [PMID: 29385316 DOI: 10.1002/hed.25092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 09/24/2017] [Accepted: 12/20/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The nasopharyngeal and parapharyngeal spaces are difficult for surgeons to access. Of the various external routes described, the maxillary swing has emerged as the gold standard because of its simplicity. However, its morbidity has led to the development of less invasive techniques. The purpose of our study was to compare the surgical anatomy of the maxillary swing with that of the endoscopic endonasal approach. METHODS Each procedure was performed on 10 anatomic specimens. The exposure and the limits obtained were evaluated. A CT scan analysis was performed. RESULTS The endoscopic endonasal approach extended the limits, offering wider exposure. The endoscopic endonasal approach made possible better visualization of deep structures and precise dissection of the parapharyngeal spaces. However, the maxillary swing provided better access to the oropharynx and could be completed 3 times faster. CONCLUSION The endoscopic endonasal approach provides excellent exposure, a wide dissection range, and precise definition of anatomic structures, making it an alternative of choice rather than the maxillary swing approach.
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Affiliation(s)
- Vivien Roger
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France.,Department of Anatomy, UNICAEN, Caen, France
| | - Vincent Patron
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France
| | - Sylvain Moreau
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France.,Department of Anatomy, UNICAEN, Caen, France
| | - Jeeve Kanagalingam
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Emmanuel Babin
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France
| | - Martin Hitier
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France.,Department of Anatomy, UNICAEN, Caen, France
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Simon F, Vacher C, Herman P, Verillaud B. Surgical landmarks of the nasopharyngeal internal carotid using the maxillary swing approach: A cadaveric study. Laryngoscope 2016; 126:1562-6. [DOI: 10.1002/lary.25870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 12/28/2022]
Affiliation(s)
- François Simon
- Department of Otorhinolaryngology; AP-HP, Lariboisière Hospital, Paris Diderot University; Paris France
| | - Christian Vacher
- Department of Maxillofacial Surgery; AP-HP, Beaujon Hospital, Paris Diderot University; Paris France
| | - Philippe Herman
- Department of Otorhinolaryngology; AP-HP, Lariboisière Hospital, Paris Diderot University; Paris France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology; AP-HP, Lariboisière Hospital, Paris Diderot University; Paris France
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Tritter AG, Selber J, Kupferman ME. Surgical Management of a Functional Paraganglioma of the Infratemporal Fossa. J Neurol Surg Rep 2015; 76:e1-7. [PMID: 26251781 PMCID: PMC4520974 DOI: 10.1055/s-0034-1383860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/07/2014] [Indexed: 12/01/2022] Open
Abstract
Background Paragangliomas are rare neural crest tumors that can manifest in the head and neck as either functional or more commonly as nonfunctional lesions. Paragangliomas of the infratemporal fossa are exceedingly rare, with no more than a handful of documented cases. Like other tumors of this space, surgical management is challenging on account of complex anatomy and nearby critical structures. Methods A 44-year-old man presented with a right infratemporal fossa functional paraganglioma. Following preemptive embolization and autonomic pharmacotherapy, his tumor was successfully resected via a transfacial maxillary swing approach. Results This case highlights the surgical management of a functional paraganglioma of the infratemporal fossa while demonstrating the effectiveness of a transfacial maxillary swing approach for both exposure and resection. Conclusion Although this report summarizes much of the literature on paragangliomas, there is still much to uncover regarding the fundamental features and genetic etiology of these lesions.
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Affiliation(s)
- Andrew G Tritter
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States ; Baylor College of Medicine, Houston, Texas, United States
| | - Jesse Selber
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Du W, Cui M, Li P, Wang J, Luo R, Qi J, Zhao M, Lou W. Complete recovery of visual disorder following surgical resection of adenoid cystic carcinoma arising in the pterygopalatine fossa: case report and review of the literature. Medicine (Baltimore) 2015; 94:e892. [PMID: 26039119 PMCID: PMC4616353 DOI: 10.1097/md.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) arising in the pterygopalatine fossa was rare, only 3 cases have been reported. In previous literature, few authors reported whether the visual deficit could be resolved following the resection of the tumor. One patient with visual dysfunction induced by ACC arising in the pterygopalatine fossa was reported. Complete visual recovery was achieved following the operation. And the patient was satisfied with the appearance and the functional results in the follow-up. Visual loss contributed by the tumor in the pterygopalatine fossa could recover in selected patients.
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Affiliation(s)
- Wei Du
- From the Department of Head and Neck and Thyroid, Affiliated Tumor Hospital of Zhengzhou University, Henan, PR China (WD, MC, PL, JW, RL, JQ, MZ); Department of Head and Neck, The First Affiliated Hospital of Zhengzhou University, Henan, PR China (WD, WL)
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Choi SA, Kim SB, Shin SY, Eun YG. Undetected metallic chopstick stabbed on neck resulting tinnitus and foreign body sensation. J Korean Neurosurg Soc 2015; 57:140-2. [PMID: 25733998 PMCID: PMC4345194 DOI: 10.3340/jkns.2015.57.2.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 04/01/2014] [Accepted: 04/06/2014] [Indexed: 12/03/2022] Open
Abstract
Penetrating neck injuries constitute 5-10% of all trauma cases. These injuries may cause life-threatening suppurative or vascular complications, but the severity and extent of damage depends upon the inflicting object and the involved structures. If significant complications are not expected, then it is best to leave the foreign body embedded and avoid surgical risks. We present a rare case of a foreign body embedded in the neck causing tinnitus and foreign body sensation.
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Affiliation(s)
- Sun A Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Bum Kim
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Youp Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Gyu Eun
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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