Endoscopic Anterior Maxillotomy: Infratemporal Fossa via Transnasal Approach

Objectives/Hypothesis: To evaluate our initial experience with a novel technique, endoscopic anterior maxillotomy (EAM), for improved access to the anterior-lateral skull base. Clinical and radioanatomic data are presented to describe and define this novel technique. Study Design: Case series. Methods: Surgical patients with lesions of the pterygopalatine fossa, infratemporal fossa, and anterior-lateral maxilla treated from 2006 to 2008 are reviewed. Demographic data and surgical technique are presented. A radioanatomic analysis pre- and post-EAM is performed to describe increased access. Matched-paired analysis was performed for statistical evaluation. Results: Thirty-two patients had surgical treatment of anterior-lateral skull base lesions. EAM was utilized in 16 cases. Fifty-six percent extended lateral to V2 and 56% extended posterior to the maxillary sinus. Complete resection was achieved in 11 patients. There was one unplanned subtotal resection. Radioanatomic measurements demonstrated an increase in the radius of surgical access to the ipsilateral skull base using the EAM when compared with both standard transnasal techniques (33.1 degrees vs. 14.8 degrees; P<.0001) and extended approaches removing the nasolacrimal duct (33.1 degrees vs. 23.5 degrees; P<.001). Similar findings were noted for lateral access to the contralateral skull base. Conclusions: Endoscopic anterior maxillotomy is a novel technical addition to the skull base surgeon's armamentarium. Radioanatomic analysis demonstrates a significant improvement in access to the anterolateral skull base.