Maxillary swing approach to the cranial base: microsurgical anatomy / 中国耳鼻咽喉头颈外科

ABSTRACT

OBJECTIVE To d e f i n e t h e microsurgical anatomy and exposure obtained by the maxillary swing approach. METHODS Ten adult cadaver specimens fixed by formalin solution were dissected under 5 to 20 times magnification. The microsurgical anatomy and measurement were performed by mimicking the maxillary swing approach. The anatomic relationship of the muscles, arteries,veins,nerves were carefully recorded. RESULTS The maxillary swing approach provides wide exposure extending from the central base to the lateral cranial base,including turkish saddle,the ipsilateral cavernous sinus,the clivus and C1,the nasopharynx,the pterygopalatine and infratemporal fossa,and the parapharyngeal space,etc. CONCLUSION The maxillary swing approach provides a suitable route for accessing lesions involving both the central and lateral cranial base. The sphenoid pterygoid process,the Eustachian tube,and the lateral pharyngeal wall separates the central cranial base from the lateral cranial base and limits anterolateral access to the central cranial base. Removing the pterygoid process provides exposure extending from the central to the lateral cranial base and allows for wide anterolateral access to the clivus and upper cervical spine. The maxillary swing approach is difficult and limited to reach the poststyloid compartment of the parapharyngeal space,the lateral region of styloid process,the horizontal segment of the petrous carotid.