Endoscopic‐assisted en‐bloc pterygomaxillectomy: Identifying an efficient and safe location for the pterygoid osteotomy.

Background: For aggressive maxillary sinus and pterygopalatine fossa (PPF) tumors, an en‐bloc pterygomaxillectomy may be indicated. Methods: Five head specimens were used to study the feasibility of an en‐bloc pterygomaxillectomy. Eighty‐five non‐pathological CT scans were used to compare the superior edge of the inferior turbinate (IT) and the middle turbinate tail (MT) as landmarks for the pterygoid osteotomy. Results: Through a combined sublabial–subperiosteal incision and transoral route, a mid‐sagittal osteotomy through the hard palate and an axial osteotomy below the infraorbital foramen were performed. For the endoscopic pterygoid osteotomy, an infra‐vidian transpterygoid approach was performed, subsequently removing the pterygomaxillectomy en‐bloc. As landmarks, the osteotomies at the level of the MT tail and IT resected the pterygoid plates completely, but the IT osteotomy was further away from the vidian canal (7.5 vs. 6 mm). Conclusions: The endoscopic‐assisted en‐bloc pterygomaxillectomy is feasible. The IT landmark is safe and ensures complete resection of the pterygoid plates. [ABSTRACT FROM AUTHOR]