Transorbital Approach to the Pterygopalatine Fossa Following Exenteration in Cadaveric Models.

Abstract

Purpose: To describe a transorbital approach to the pterygopalatine fossa following total exenteration.

Methods: Cadaveric dissection study where 5 head specimens (10 orbits) were dissected. The technique involved (1) infraorbital nerve identification, (2) creation of a posterior osteotomy around the orbitomaxillary segment of the infraorbital nerve, and (3) removal of the posterior maxillary sinus wall. The pterygopalatine segment of V2 (pV2) and the third segment of the internal maxillary artery were visualized.

Results: The orbital floor defect approximated a parallelogram, with its lateral, medial, anterior, and posterior borders measuring 13.2 mm × 13.5 mm × 7.9 mm × 8.3 mm, respectively. To access pV2, the posterior maxillary wall defect was 10.6 mm (height) × 11.4 mm (width), respectively. To access the internal maxillary artery, this bony defect increased to 17.1 mm (height) × 12.2 mm (width), respectively.

Conclusions: Transorbital approaches to the pterygopalatine fossa following exenteration are feasible. Indications include orbital tumors with extension to the apex and pterygopalatine fossa, such as squamous cell carcinoma.