2025 Proffered Presentations
S114: ENDOSCOPIC TRANSORAL PARAMAXILLARY APPROACH TO THE FORAMEN OVALE; REJUVENATION OF THE HARTEL'S METHOD
Jae-Sung Park1; Wonil Joo2; Doo-Sik Kong3; 1Seoul St. Mary's Hospital; 2Eunpyeong St. Mary's Hospital; 3Samsung Medical Center
Objective: This study introduces a novel, minimally invasive approach to the infratemporal fossa (ITF) using Hartel’s method for trigeminal neuralgia. Unlike traditional open approaches to the ITF, our technique employs a transoral endoscopic method. We incorporate stepwise cadaveric dissection to enhance understanding of this innovative technique.
Methods: Three human cadaveric heads (six sides) were dissected. A stepwise anatomical dissection was performed to visualize the relevant anatomies during the procedure. Critical neurovascular structures within the ITF were further dissected and demonstrated.
Results: Stepwise anatomical cadaveric dissection identified several consistent structures that can be used for an appropriate surgical approach. The consistent structures and their relative locations were demonstrated in endoscopic views. The extracranial portion of the trigeminal nerve was further dissected and presented. Relevant vascular structures, such as the internal maxillary artery (IMA), middle meningeal artery (MMA), and pterygoid venous plexus were also shown. These findings were successfully applied in a clinical case, resulting in the treatment of the patient with minimal morbidity, specifically facial numbness.
Conclusion: This study is the first to properly demonstrate the transoral paramaxillary approach with detailed anatomical descriptions. With this innovative approach, lesions in the ITF, including those around the foramen ovale, will have another access route with reduced morbidities.
Keywords: Endoscope, transoral surgery, foramen ovale, neuroanatomy
Figure 1. Stepwise anatomical dissection to the foramen ovale
