Endoscopic Transnasal Transmaxillary Transpterygoid Approach to the Parapharyngeal Space: An Anatomic Study

Background: The aim of this study was to assess the feasibility of an endoscopic approach to the parapharyngeal space through a transnasal route. For this purpose, an anatomic study was conducted. Material and Methods: The target area was studied separately on each side in 4 adult cadaver heads. To simulate actual endoscopic surgery, the dissection was performed thoroughly under the rigid endoscope. The surgical steps and extent of surrounding tissue resection necessary for the approach were evaluated. Results: Both the pre- and poststyloid compartments could be exposed with restricted sacrifice of the surrounding tissue around the pterygoid process. Adding a wide sphenoidotomy and sub-petrous bone resection, the surgical exposure could be extended at the medial temporal skull base including the medial infratemporal fossa. Conclusion: Although its usefulness has to be further verified in the clinical setting, the present results of the anatomic dissection indicate the potential of the approach to become a novel technique for treatment of a lesion in the parapharyngeal space.