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Endoscopic transvestibular anatomy of the infratemporal fossa and upper parapharyngeal spaces for clinical surgery: a cadaver study

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Abstract

Aims

To investigate the anatomy of the infratemporal fossa (ITF) and to discuss the practicality of endoscopic transvestibular surgery for an ITF tumor.

Methods

Five fresh cadaveric specimens (10 sides) with vascular silicone injection were prepared for endoscopic anatomy. A transvestibular vertical incision was made along the ramus of the mandible, and pivotal nerves, arteries, and muscles were exposed to sculpt the anatomic landmarks of the ITF.

Results

The endoscopic transvestibular approach exposed the detailed structure of the ITF. The buccinator muscle and the adjoining superior pharyngeal constrictor muscle shaped the paramedian border of the ITF, while the medial pterygoid muscle (MPM) and the lateral pterygoid muscle formed the lateral border. The ITF was delimited by the skull base in the upper margin, and it was proximal to the parapharyngeal space in the inferior part. The inferior alveolar nerve was the first reference point, and the maxillary artery and the lateral pterygoid muscle were also the landmarks of the ITF. The lingual nerve, the eustachian tube (ET), and the middle meningeal artery were also located in the posterior part of the ITF.

Conclusion

The endoscopic transvestibular approach provides a feasible and facile corridor to the ITF. With accurate hemostasis, this approach may provide another option for accessing the ITF for removal of tumors.

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Abbreviations

ITF:

Infratemporal fossa

SPCM:

Superior pharyngeal constrictor muscle

MPM:

Medial pterygoid muscle

LPM:

Lateral pterygoid muscle

PPS:

Parapharyngeal space

ICA:

Internal carotid artery

IJV:

Internal jugular vein

MCP:

Mandibular coronoid process

IAN:

Inferior alveolar nerve

PMR:

Pterygomandibular raphe

MMA:

Middle meningeal artery

ET:

Eustachian tube

TMJ:

Temporomandibular joint

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Acknowledgments

We are very grateful to Deng Wenyao and Hu Chen for their selfless assistance and admirable work during the anatomic project.

Funding

This research is supported by the Scientific Research Project of Science and Technology Commission of Shanghai Municipality (Project Number: 16411960600).

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital, Fudan University, Fenyang Road Num83, Xuhui District, Shanghai, 200031, China

    Yi Fang, Haitao Wu, Weidong Zhao & Lei Cheng

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  1. Yi Fang
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  2. Haitao Wu
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  3. Weidong Zhao
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  4. Lei Cheng
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Correspondence to Lei Cheng.

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Fang, Y., Wu, H., Zhao, W. et al. Endoscopic transvestibular anatomy of the infratemporal fossa and upper parapharyngeal spaces for clinical surgery: a cadaver study. Eur Arch Otorhinolaryngol 276, 1799–1807 (2019). https://doi.org/10.1007/s00405-019-05410-y

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