Lateral Molar Approach-Driven Transoral Endoscopic Procedure for Benign Infratemporal Fossa Tumor Resection

Benign infratemporal fossa tumors necessitate complete resection while preserving neurovascular integrity. Conventional open approaches risk delayed bone healing, occlusal dysfunction, severe facial scarring, and iatrogenic neurovascular injury. We propose an endoscopic-assisted plasma ablation technique via a lateral molar transoral approach to address these limitations. A 55-year-old female with a 2.5 × 2 cm right infratemporal fossa tumor underwent the novel procedure. A 4-5 cm mucosal incision lateral to the molar established an osteotomy-free corridor along the mandibular ramus. The technique integrated a 4-mm 0° rigid endoscope for magnified visualization and a low-temperature plasma ablation device for extracapsular dissection with simultaneous cutting/coagulation, minimizing thermal damage. Intraoperative neurophysiological monitoring safeguarded the mandibular nerve. Postoperative recovery metrics, MRI, and histopathology were analyzed. Complete tumor resection was achieved in 122 min with 50 mL blood loss. Postoperative MRI confirmed no residual lesions, but they were replaced by fibrotic scar tissue. Mandibular function (physiological mouth opening ≥35 mm) and facial sensation recovered by postoperative day 3. No hematoma, infection, or neurological deficits occurred. Histopathology confirmed a benign vascular malformation (SMA+, CD31/CD34+). Aesthetic outcomes were optimal, with no visible scarring (patient satisfaction: 10/10). The endoscopic-assisted plasma ablation technique via a transoral lateral molar approach enables precise, minimally invasive resection of anteromedial infratemporal fossa tumors (≤4 cm), avoiding osteotomy and external incisions. Synergizing anatomic landmark guidance, energy-selective ablation, and intraoperative neuroprotection, this method optimizes functional preservation and aesthetic outcomes while adhering to microsurgical principles. Standardization requires advanced endoscopic skills and warrants further validation in larger cohorts.