Endoscopic Endonasal Approach to the Pterygopalatine Fossa and Infratemporal Fossa: Comparison of the Prelacrimal and Denker's Corridors.

Abstract

Both the endoscopic transnasal Denker's and prelacrimal approaches provide surgical access to the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). This study compares the potential maximum exposure of the PPF and ITF and quantifies the difference in surgical freedom via endoscopic Denker's and prelacrimal approaches. Six cadaveric specimens (12 sides) were dissected using a prelacrimal approach on one side and an endoscopic Denker's approach on the contralateral side. The contents of the PPF and ITF were sequentially exposed. Surgical freedom for each corridor was subsequently calculated. This study confirms that both the prelacrimal and Denker's approaches provide adequate exposure of the PPF and ITF. The maximum exposure boundaries were similar for both approaches, including the middle cranial fossa superiorly, floor of the maxillary sinus inferiorly, zygomatic arch and temporomandibular joint laterally, and post-styloid space posteriorly. However, the data revealed a statistically significant difference (p < 0.05) regarding the surgical freedom of the prelacrimal (388.17 ± 32.86 mm2) and the endoscopic Denker's approaches (906.35 ± 38.38 mm2). When compared with an endoscopic Denker's approach, a prelacrimal approach seems to achieve a similar extent of exposure (ie, visualization) of the PPF and ITF. Nonetheless, the endoscopic Denker's approach offers superior surgical freedom; thus, it is preferred for the management of complex lesions which requires increased instrument maneuverability with a 3- or 4-handed technique.