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J Neurol Surg B Skull Base 2021; 82(04): 437-442
DOI: 10.1055/s-0040-1713106
Original Article

Advanced Endoscopic Endonasal Approach to the Pterygopalatine Fossa and Orbit: The Endoscopic Tri-port Approach

Kazuhiro Omura
1   Department of Otolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
2   Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
,
Kazuhiro Nomura
3   Department of Otolaryngology, Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
,
Ryosuke Mori
4   Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
,
Yudo Ishii
4   Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
,
Yasuhiro Tanaka
2   Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
,
Nobuyoshi Otori
1   Department of Otolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
,
Hiromi Kojima
1   Department of Otolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Abstract

Objective The pterygopalatine fossa (PPF) is a narrow space situated posterior to the maxillary sinus. While external approaches have been used to treat tumors of the PPF, recent endoscopic approaches have become favored as an alternative; we developed an endoscopic tri-port approach, which provides wide surgical corridor with minimal invasion, for PPF. This report aims to introduce and verify the new approach.

Design Case series.

Setting A tertiary referral hospital.

Participants We reviewed 11 patients with PPF or orbital tumors who were treated with the endoscopic tri-port approach.

Main Outcome Measures Accessing tri-port approach's effects and limitations.

Results When the tumor was located in the PPF or orbit without intracranial invasion, en bloc resection was achieved in six patients. With the exception of one patient, the nasal septum was preserved if not used for skull base reconstruction. If not invaded by a tumor or necessary for reconstruction, the inferior and middle turbinates were preserved.

Conclusion The endoscopic tri-port approach provides an excellent surgical view and wide corridor and not requires an external approach, including a gingival incision.

Keywords

endoscopic sinus surgery - endoscopic skull base surgery - minimally invasive surgery - pterygopalatine fossa - tissue preservation


Publication History

Received: 08 November 2019

Accepted: 26 April 2020

Article published online:
19 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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