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ORIGINAL ARTICLE
Year : 2018  |  Volume : 34  |  Issue : 4  |  Page : 278-282

Clinical implications of transpterygoid approach to mandibular nerve


1 Department of Otolaryngology-Head and Neck Surgery, Alexandria University, Alexandria; Department of Otolarynglogy-Head and Neck Surgery, OHIO State University Wexner Medical Center, Columbus, Ohio, Egypt
2 Department of Otolarynglogy-Head and Neck Surgery, OHIO State University Wexner Medical Center, Columbus, Ohio, USA
3 Department of Otolaryngology-Head and Neck Surgery, University Hospital Birmingham, Birmingham, UK
4 Department of Otolaryngology-Head and Neck Surgery, Alexandria University, Alexandria, Egypt

Correspondence Address:
Ahmed Youssef
Head & Neck/Reconstructive Fellow-University of Newcastle, NSW-Australia, 2305; Clinical Fellow Head & Neck/Skull Base Surgery, University Hospital Birmingham, Birmingham, UK; Lecturer Otolaryngology & Head and Neck Surgery-Faculty of Medicine-Alexandria University
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejo.ejo_30_18

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Background The endonasal transpterygoid approach has been very popular as a standard approach to the pterygopalatine and infratemporal fossa. However, its implications actually extend beyond these regions to include access to the middle cranial fossa and parapharyngeal space. Objective The aim was to illustrate the anatomical landmarks of the endoscopic transpterygoid approach especially the mandibular nerve and clinical implication of this approach through illustrated case presentation. Materials and methods A cadaveric study was performed on three cadaveric adult specimens. Endoscopic medial maxillectomy, Sturman Canefield approach, and completion of transpterygoid approach were done to visualize the different anatomical landmarks, especially the mandibular nerve. An example of clinical application of transpterygoid approach is an illustrated case to biopsy a perineural spread of squamous cell cancer along the mandibular nerve in the lateral wall of cavernous sinus. Conclusion Endoscopic transpterygoid approach is very useful to resect most of benign and some malignant tumors that involve the infratemporal fossa and middle cranial fossa. Good understanding of the V3 anatomy helps in the resection of tumors extending to the infratemporal fossa and poststyloid parapharyngeal space.


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