49 - Anterior and Subtemporal Approaches to the Infratemporal Fossa

Abstract

The infratemporal fossa (ITF) is a potential space bounded by the greater wing of the sphenoid and the temporal bone. The ITF is anatomically complex and multiple neurovascular foramina connect the ITF to the middle cranial fossa. Given its close proximity to critical neurovascular structures and the variety of routes for potential tumor spread, multiple surgical approaches have been described and utilized dependent on the tumor extent and relationship with these critical structures. The objective of this chapter is to describe the anterior and subtemporal approaches to the ITF, thereby providing a detailed description of the various techniques including the preauricular (subtemporal) approach, postauricular (transtemporal) approach, lateral Fisch approaches, anterior transfacial (facial translocation) approach, and transorbital approach. To add context, it also addresses the diagnostic and staging work-up for tumors of the ITF. Furthermore, it discusses the perioperative, rehabilitative, and reconstruction considerations, as well as potential complications, including neurovascular and postoperative concerns such as cerebral ischemia, hemorrhage, trigeminal and frontal nerve deficits, trismus, and cosmetic deformities.