Quantitative Comparison Of Endoscopically Assisted Endonasal, Sublabial And Transorbital Transmaxillary Approaches To The Anterolateral Skull Base

Objectives The aim of this anatomical study is to make quantitative comparison among three endoscopic approaches, encompassing contralateral endonasal transseptal transmaxillary transpterygoid approach (contralateral EEA), endoscopic sublabial transmaxillary transalisphenoid (Caldwell-Luc) approach and endoscopic transorbital transmaxillary approach through inferior orbital fissure (ETOA), to the anterolateral skull base for assisting preoperative planning. Design & Participants Anatomical dissections were performed in four adult cadaveric heads bilaterally using three endoscopic transmaxillary approaches described above. Setting Skull Base Laboratory at the National Defense Medical Center. Main outcome measures The area of exposure, angles of attack and depth of surgical corridor of each approach were measured and obtained for statistical comparison. Results The ETOA had significantly larger exposure over middle cranial fossa (731.40 +/- 80.08 mm(2)) than contralateral EEA (266.60 +/- 46.74 mm(2)) and Caldwell-Luc approach (468.40 +/- 59.67 mm(2)). In comparison with contralateral EEA and Caldwell-Luc approach, the ETOA offered significantly greater angles of attack and shorter depth of surgical corridor (P < .05 for all comparisons). Conclusions The ETOA is the superior choice for target lesion occupying multiple compartments with its epicentre located in the middle cranial fossa or superior portion of infratemporal fossa.