Paramaxillary (Transfacial) Approach for CT-Guided Head and Neck Biopsies

Deep-seated lesions within the head and neck, such as those in the parapharyngeal space, carotid space, or skull base, present a significant challenge for percutaneous biopsy due to their proximity to critical neurovascular structures and difficult visualization with ultrasound. The paramaxillary approach provides a safe, reproducible, and effective CT-guided pathway to access these difficult areas. This video article demonstrates the detailed anatomy and technical considerations of utilizing this approach. Indications, relative contraindications, and biopsy selection (FNA vs. core biopsy) are discussed. The procedure is illustrated with case examples, highlighting the necessary anatomical landmarks, potential pitfalls, and tips for successful tissue acquisition. This technique serves as a foundational roadmap for interventional and neuroradiologists performing highly precise, low-morbidity biopsies of challenging head and neck masses. The patient whose images appear in this video article provided explicit, written consent for their use. VIDEO.