Infratemporal fossa approach: the modified zygomatico-transmandibular approach / 대한악안면성형재건외과학회지

BACKGROUND: The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. METHODS: A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors’ diverse clinical experiences. RESULTS: We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. CONCLUSIONS: An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.

Giant Cell Tumor of the Temporal Bone / 대한이비인후과학회지

Giant cell tumor of bone is an uncommon, primary neoplasm that occurs chiefly in the ends of the long bones. Giant cell tumor is rarely encountered in the skull, where it preferentially involves the sphenoid, ethmoid, and temporal bones. Radiographically, there are no characteristic findings which can be regarded as typical of a giant cell tumor. Therefore, the diagnosis must be made by biopsy. This tumor is characterized by benign histologic features, but it can be locally aggressive and can even metastasize. Complete surgical excision is the treatment of choice for giant cell tumor. We have experienced a case of giant cell tumor of the temporal bone which was removed with infratemporal fossa approach type B. So, we report with review of literatures.

Infratemporal Fossa Approach to Lesions in the Base of the Skull

The technique and results of infratemporal fossa approach of jugular formamen meuroma and clivus chordoma are presented. The infratemporal fossa approach allowed radical removal of jugualr foramen neuroma and effective palliative removal of clivus chordoma. The basic features of infratemporal fossa approach are permanent anterior displacement of the facial nerve, subtotal petrosectomy and obliteration of the middle ear cleft.