Endoscopic approach to the infratemporal fossa

Introduction: Multiple surgical approaches have been described to access the infratemporal fossa. One of them is the endoscopic endonasal transpterygoid approach to the infratemporal fossa. The endoscopic endonasal transpterygoid approach is considered the best to access the midline structures such as the nasopharynx, Eustachian tube, sella, and clivus. Through this work, we try to describe the anatomical structures and landmarks of the infratemporal fossa from the endosopic endonasal transpterygoid point of view. Methods: A cadaveric study was performed on five adult specimens. Endoscopic medial maxillectomy and complete resection of the posterior wall of the maxillary antrum were performed. Extension of the medial maxillectomy anteriorly was done to reach the lateral part of the infratemporal fossa. Endoscopic Denker’s or Sturman–Canfield approach was done. Dissection of the pterygopalatine fossa was done with identification of maxillary artery branches, V2 (maxillary nerve) and masticatory muscles. Resection of the lateral pterygoid muscle and drilling the lateral pterygoid plate improve exposure of the infratemporal fossa, including V3 (mandibular nerve), which lies posterior to the lateral pterygoid plate. Results: A total of ten infratemporal and pterygopalatine fossae (five cadaveric specimens) were dissected endoscopically using a transpterygoid approach. Dissection of different anatomical structures in the infratemporal fossa was done to describe the anatomical structures and landmarks of the infratemporal fossa. Conclusions: Endoscopic endonasal transpterygoid approach is considered one of the most useful surgical solutions to manage selected tumors that involve the infratemporal fossa. A good understanding of the endoscopic anatomy of infratemporal fossa allows safe and complete resection of lesions arising or extending to infratemporal fossa