An Assessment of Exposure and Maneuverability to the Upper Parapharyngeal Space Through the Multiport Endoscopic Endonasal Transpterygoid and Anterior Transmaxillary Techniques

BACKGROUND: Treating tumors that extend into the upper parapharyngeal space (UPPS) is challenging, given the region's anatomical complexity and its proximity to the parapharyngeal carotid artery (ppICA) and the middle cranial fossa. Endoscopic techniques offer optimal surgical outcomes while also reducing morbidity related to open approaches. METHODS: Exposure and maneuverability were evaluated toward the UPPS using a multiportal endoscopic technique combining the anterior transmaxillary (TMA) and endonasal transpterygoid approaches. Bilateral stepwise dissections were performed in four specimens. Measurements of linear trajectories, angles of exposure, and surgical corridor volumes were obtained. RESULTS: The TMA provided superior maneuverability around the uppermost ppICA portion within the UPPS, while the endonasal corridors offered a more direct trajectory to its lowest segment. CONCLUSION: Combining the TMA and endonasal transpterygoid approaches enhances surgical control over critical neurovascular structures within the UPPS by addressing the limitations of each technique used independently.