Intraoral Endoscopic Approach to Excision of an Infratemporal Fossa Tumour

Abstract

Introduction: The infratemporal fossa is an inverted pyramid shaped structure that lies at the skull base, posterior to the maxillary sinus. It has a complex anatomy due to its relationship to various important vascular and neural channels. Surgical approaches to this region, via the lateral skull base and access mandibulotomies, have high morbidity. By our minimally invasive intra-oral endoscopic technique, an external incision, bony osteotomies and cranial nerve palsies were avoided with an expedited road to recovery and shorter hospital stay.

Case Report: A middle aged lady who presented with left sided facial swelling and numbness was evaluated for the same with a Diagnostic nasal endoscopy and imaging. MRI of the maxilla with contrast revealed a well-defined left infra-temporal fossa soft tissue signal intensity mass, which was subsequently planned for intra-oral endoscopic removal. The surgery was performed via a transvestibular-paramandibular incision through which the endoscope was passed, structures delineated and tumour removed piece meal. Immunohistochemical analysis confirmed that it was a Spindle cell Rhabdomyosarcoma. Hence, she was given post operative chemoradiotherapy and is currently one year post surgery, with good outcomes.  

Discussion

The infratemporal fossa has a varied and complex anatomy, due to its interior location and multiple important neurovascular structures within it. This intra-oral endoscopic approach, although challenging for the novice surgeon, avoided an external scar, providing better cosmesis and also had lesser patient morbidity related to wound gaping and dehiscence. It also allowed a direct and magnified visualization of the neuro-vascular structures in that region, aiding in tumour removal.