Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-16T08:24:58.120Z Has data issue: false hasContentIssue false
  • English
  • Français

Transnasal endoscopic management of angiofibroma extending to pterygopalatine and infratemporal fossae

Published online by Cambridge University Press:  19 April 2011

S M El Morsy  and
Y W Khafagy
S M El Morsy*
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Egypt
Y W Khafagy
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Egypt
*
Address for correspondence: Dr Shawky Mahmoud El Morsy, Assistant Professor of Otolaryngology, Mansoura University, Faculty of Medicine Otorhinolaryngology Department, Elgomhoria street, Mansoura, PO 35516, Egypt-Dakhlia Fax: +20502267016 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Surgical approaches to the pterygopalatine and infratemporal fossae are complex and cause significant morbidity. The commonest benign tumour to extend to the pterygopalatine and infratemporal fossae is angiofibroma.

Patients and methods:

This prospective study included 15 male patients aged 12–27 years with recurrent, severe epistaxis. After computed tomography and magnetic resonance imaging, a modified Wormald and Robinson's two-surgeon approach was used. Follow up, with endoscopy and magnetic resonance imaging, ranged from two to five years.

Results:

Twelve patients were cured (endoscopically and radiologically). Three patients suffered recurrence, one each in the lateral sphenoid wall, pterygoid canal and infratemporal fossa. Revision surgery was performed, but one patient suffered another recurrence (lateral sphenoid wall with cavernous sinus infiltration) and was referred for gamma knife surgery.

Conclusion:

This endoscopic two-surgeon technique is an excellent approach for managing angiofibroma extending to the pterygopalatine and infratemporal fossae. Our modification markedly decreased morbidity by avoiding septum opening and sublabial incision, and by enabling better haemostasis (via maxillary artery control). Recurrence may be minimised by careful examination of the lateral sphenoid wall, pterygoid canal and infratemporal fossa pterygoid muscles.

Keywords

Endoscopic approachPtyrgopalatine fossaInfratemporal fossaAngiofibroma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 7 , July 2011 , pp. 701 - 705
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at Rhinology World Conference, 15–19 April 2009, Philadelphia, Pennsylvania, USA

References

1Grant, J. An Atlas of Anatomy. Baltimore: Williams & Wilkins, 1972Google Scholar
2Van Huijzen, C. Anatomy of the skull base and the infratemporal fossa. Adv Otorhinolaryngol 1984;34:242–53Google ScholarPubMed
3Fisch, U, Fagan, P, Valavanis, A. The infratemporal fossa approach for the lateral skull base. Otolaryngol Clin North Am 1984;17:513–52CrossRefGoogle ScholarPubMed
4Cummings, CW, Fredrickson, JM, Harker, LA. Otolaryngology – Head and Neck Surgery, 3rd edn.St Louis: Mosby Year Book, 1998Google Scholar
5Carrau, RL, Vescan, AD, Snyderman, CH, Kassam, AB. Surgical approaches to the infratemporal fossa. In: (Operative Otolaryngology head and neck surgery) Myers Operative Otolaryngology. Head and Neck Surgery, 2nd edn. Eugene N Myers Saunders. University of Pittsburgh, PA: Elsevier, 2008;3:997–1022CrossRefGoogle Scholar
6Fisch, U. Infratemporal fossa approach for lesions in the temporal bone and base of the skull. Adv Otorhinolaryngol 1984;34:254–66Google ScholarPubMed
7Sekhar, LN, Schramm, VL Jr, Jones, NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms. J Neurosurg 1987;67:488–99CrossRefGoogle ScholarPubMed
8Janecka, IP. Classification of the facial translocation approach to the skull base. Otolaryngol Head Neck Surg 1995;112:579–85Google ScholarPubMed
9Wormald, PJ, Robinson, S. Transnasal endoscopic resection of benign tumours occurring from or extending into the infratemporal fossa. Oper Tech Otolaryngol Head Neck surgery 2006;17:97–101CrossRefGoogle Scholar
10Robinson, S, Patel, N, Wormald, PJ. Endoscopic management of benign tumors extending into the infratemporal fossa: a two-surgeon transnasal approach. Laryngoscope 2005;115:1818–22CrossRefGoogle ScholarPubMed
11Radkowski, D, McGill, T, Heal, GB, Ohlms, L, Jones, DT. Angiofibroma. Changes in staging and treatment. Arch Otolaryngol Head Neck Surg 1996;122:122–9CrossRefGoogle ScholarPubMed
12Hartnick, CJ, Lacy, PD, Myer, CM 3rd. Endoscopic evaluation of the infratemporal fossa. Laryngoscope 2001;111:353–5CrossRefGoogle ScholarPubMed
13Howard, DJ, Lund, VJ. The role of midfacial degloving in modern rhinological practice. J Laryngol Otol 1999;113:885–7CrossRefGoogle ScholarPubMed
14Kassam, AB, Gardner, P, Synderman, C, Mintz, A, Carrau, R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa and infratemporal fossa. Neurosurg Focus. 2005;19:E6CrossRefGoogle Scholar
15Goyal, P, Leung, MK, Hwang, PH. Endoscopic approach to ITF for treatment of invasive fungal sinusitis. Am J Rhinol Allergy 2009;23:100–4CrossRefGoogle Scholar
16Khalifa, MA, Ragab, SM. Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension. Inter J Pediatric Otolaryngol 2008;72:1855–60. Epub 2008 Oct 25.CrossRefGoogle ScholarPubMed
17Ong, BC, Gore, PA, Donellan, MB, Kertesz, T, Teo, C. Endoscopic sublabial transmaxillary approach to the rostral middle fossa. Neurosurgery 2008;62:30–6Google Scholar
18Hartnick, J, Myseros, JS, Myer, CM. Endoscopic access to the infratemporal fossa and skull base. Arch Otolaryngol Head Neck Surg 2001;127:1325–7CrossRefGoogle Scholar
19Herzallah, IR, Germani, R, Casiano, RR. Endoscopic transnasal study of the infratemporal fossa: a new orientation. Otolaryngol Head Neck Surg 2009;140:861–5CrossRefGoogle ScholarPubMed