Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space

Background: Lesions of the upper parapharyngeal space (UPPS) present a surgical challenge. The objective of this study was to ascertain the feasibility of a novel technique of modified transpterygoid approach to the UPPS. Methods: Six fresh cadaveric specimens (12 sides) were dissected, developing a technique that includes en bloc mobilization of the lateral pterygoid plate and muscle to access the UPPS. Results: Following an endoscopic Denker's approach and the removal of posterolateral wall of the antrum, the lateral pterygoid plate was detached from the pterygoid process. Subsequently, the lateral pterygoid plate and muscle were displaced laterally as a unit, allowing the identification of the posterior trunk of V₃ and the fat in prestyloid compartment. Dissecting off the styloid aponeurosis affords entering the poststyloid UPPS exposing the internal carotid artery, internal jugular vein, and cranial nerves IX to XII. Conclusion: This novel modification of the endonasal transpterygoid approach offers a viable alternative for access to the UPPS.