Endoscopic Transoral Approach to The Infratemporal Fossa

We describe an endoscopic transoral approach to the infratemporal fossa (IF) developed at our department. The approach was conceived starting from our experience in endoscopic treatment of condyle fractures to avoid the complications related to trans facial approaches, such as facial nerve palsy. From January 2010 to January 2018 54 patients affected by IF lesions were observed. Signs and symptoms upon observation were retromandibular swelling in 60% of the patients, mandibular deviation in 40%, pain in 60%, alveolar nerve numbness in 20%, trismus in 20%, and limited mouth opening in 80%. The latter data was pre-operatively evaluated with a calliper and electrokinesiography. All patients were initially studied with cone beam computed tomography scan and a magnetic resonance imaging with enhancement was subsequently performed to evaluate the relationship between the lesions, internal maxillary artery, and other structures of the ITF. 10 out of 54 patients received endoscopic transoral surgery. Using 0 and 45 degree angled 4 mm optics, the entire lateral middle skull base and the infratemporal fossa were explored without damaging the nearby neurovascular structures. Of the 10 patients, three had complete removal of osteochondroma, four had osteomas, one underwent to a middle skull base biopsy resulted in a brown tumour, one had V3 neurinoma and one resulted to be a pleomorphic adenoma. In one case, postoperative numbness of the alveolar nerve was observed. Two cases presented infection and oral mucosa healing delay. The surgical approach utilized turned out to be valid not only for glenoid fossa exposure but even for the middle skull base and the infratemporal fossa management. Further use of this approach will allow us to determine its potential in treating malignancies.