الفهرس 
Review pterygopalatine fossaOnly 14 pages are availabe for public view
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Abstract
The current study was a comparative prospective study conducted on twenty patients recruited from Otorhinolaryngology Department, Menoufia Faculty of Medicine, from 2020 to 2023. The study was conducted after approval of the institutional review board of Menoufia Faculty of Medicine. A written informed consent was taken from every patient before participation in the study.
The patients of the study were selected according to the following inclusion and exclusion criteria, to be included in the study, every patient should have all of the following: age above 12 years, patients diagnosed as having a mass in pterygopalatine or infratemporal fossa or having interractable posterior epistaxis and the lateral boundary of tumor did not exceed the mandibular ramus.
To be excluded the mass had an intracranial or orbital infiltration or surgical unfitness like bleeding tendency, uncontrolled systemic diseases including diabetes mellitus and hypertension.
The patients is divided into two groups:
a. Anterior transmaxillary approach. b. Modified endoscopic transnasal transmaxillary approach (modified Denkers approach).
After preoperative assessment, operative technique were done (nine open and eleven endoscopic), and operative evaluation of the time, blood loss, accessibility and possible complication of each approach were assessed. Postoperative follow up CT done immediately to exclude postoperative hematoma, then 3, 6, 12 month follow up MRI was done.
Among the twenty patients including seventeen males and three females, the age ranged from 13 to 75 years in open group and from 14 to70 years in endoscopic group. All lesions were enhanced on the pre-operative MRI, with clear boundary in most patients and unclear in one patient. Nine patients managed with open approach and eleven with endoscopic transnasal transmaxillary approach.
In open group the pathology were 4 cases of JNA, 3 cases of inverted papilloma one of which was recurrent, one case of SCC, one case of adenocarcinoma of maxillary sinus.
In endoscopic group the pathology were 6 cases of JNA, 4 cases of inverted papilloma and one case of SCC.
The tumors were resected piecemeal. No hematoma in the surgical area was found in the postoperative CT.
A nasal surgical questionnaire for postoperative nasal symptoms was done one week after surgery. Nasal symptoms (nasal obstruction, crustation, sneezing, bleeding, secretion, and nasal pain) were assessed either, none, mild, moderate, or severe.
Endoscopic assessment of the nose was done 4 weeks postoperative to assess the degree of crustation and nasal adhesions whether absent, mild, or severe.
Regarding postoperative clinical assessment done one week after surgery, we found that in the endoscopic group there was nasal crusts due to manipulation on mucosa, sneezing as a result of irritation of nasal mucosa and nasal obstruction due to presence of crustation. In the open group, there was facial pain, paresthesia of face and teeth due to irritation of trigeminal sensory nerves and bleeding due to rich vascularity of both fossa. Also, we found nasal adhesion and crustation were significant in endoscopic group.
We noted that postoperative complications differ between the open and endoscopic groups. In the open group, there was facial swelling in 44% due to interruption of lymphatics drainage and manipulation of face, numbness of face in 44% due to affection of sensory facial branches and infiltration by the tumor, also paresthesia of teeth in 22% as result of manipulation on inferior wall of maxillary sinus. While in the endoscopic group, there was ecchymosis of eye in 27 %, periorbital edema in 27 % due to manipulation on medial wall of orbit and lamina papyracea, also hemorrhage was present in 27% which is mucosal bleeding and from sphenopalatine artery also.