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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Neurol+Surg+B+Skull+Base
2014 ; 75
(5
): 346-53
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Comparison of surgical freedom and area of exposure in three endoscopic
transmaxillary approaches to the anterolateral cranial base
#MMPMID25276600
Elhadi AM
; Almefty KK
; Mendes GA
; Kalani MY
; Nakaji P
; Dru A
; Preul MC
; Little AS
J Neurol Surg B Skull Base
2014[Oct]; 75
(5
): 346-53
PMID25276600
show ga
Objective?Endoscopic ipsilateral endonasal transmaxillary, contralateral
endonasal transseptal transmaxillary, and Caldwell-Luc approaches can access
lesions within the retromaxillary space and pterygopalatine fossa. We compared
the exposure and surgical freedom of these transmaxillary approaches to assist
with surgical decision making. Design?Four cadaveric heads were dissected
bilaterally using the three approaches just described. Prior to dissection,
stereotactic computed tomography (CT) scans were obtained on each head to obtain
anatomical measurements. Surgical freedom and area of exposure were determined by
stereotaxis. Main Outcome Measures?Area of exposure was calculated as the extent
of the orbital floor, maxillary sinus floor, nasal floor, and mandibular ramus
exposed through each approach. Surgical freedom was the area through which the
proximal end of the endoscope could be freely moved while moving the tip of the
endoscope to the edges of the exposed area. Results?The mean exposed area was
similar: 9.9?±?2.5 cm(2) (Caldwell-Luc), 10.4?±?2.6 cm(2) (ipsilateral
endonasal), and 10.1?±?2.1 cm(2) (contralateral transseptal) (p?>?0.05). The
surgical freedom of the Caldwell-Luc approach (113?±?7 cm(2)) was greater than
for either endonasal approach, 76 cm(2?)±?15 (p?=?0.001) (ipsilateral endonasal)
and 83 cm(2)?±?15 (p?=?0.003) contralateral transseptal. Conclusions?Our work
demonstrates that the Caldwell-Luc endonasal approach offers greater surgical
freedom than either approach for anterolateral skull base targets, although these
approaches offer similar exposure.