Endoscopic Endo nasal Dissection of the Pterygopalatine fossa...

A Allo on ng g w wiit th h m mo or re e t tr ra ad diit tiio on na all s su ur rg giic ca all a ap pp pr ro oa ac ch he es s t to o t th he e I IT TF F,, P PP PF F a an nd d p po os st t- -s st ty yllo oiid d

s sp pa ac ce e,, t th he e e en nd do os sc co op piic c t te ec ch hn niiq qu ue e iis s a a f fe ea as siib blle e s su ur rg giic ca all o op pt tiio on n.. P Pr re ec ciis se e a an na at to om miic ca all

k kn no ow wlle ed dg ge e f fr ro om m a a e en nd do on na as sa all e en nd do os sc co op piic c p pe er rs sp pe ec ct tiiv ve e s sh ho ou ulld d f fu ur rt th he er r iin nc cr re ea as se e s sa af fe et ty y

a an nd d e ef fi fic ca ac cy y..

T Th he e m mo os st t iim mp po or rt ta an nt t lla an nd dm ma ar rk ks s iin n t th he e t tr ra an ns sn na as sa all e en nd do os sc co op piic c a ap pp pr ro oa ac ch h t to o t th he e I IT TF F a an nd d

p po os st t- -s st ty yllo oiid d s sp pa ac ce e a ar re e t th he e p pt te er ry yg go oiid d p plla at te es s,, V V3 3,, t th he e E Eu us st ta ac ch hiia an n t tu ub br re e a an nd d t th he e s st ty yllo oiid d

p pr ro oc ce es ss s..

T Th he e m mo os st t iim mp po or rt ta an nt t lla an nd dm ma ar rk k f fo or r t th he e llo oc ca at tiio on n o of f p po os st t- -s st ty yllo oiid d s st tr ru uc ct tu ur re es s iis s t th he e

c ca ar rt tiilla ag giin no ou us s p po or rt tiio on n o of f t th he e E Eu us st ta ac ch hiia an n t tu ub be e.. T Th he e E Eu us st ta ac ch hiia an n t tu ub be e iis s a allw wa ay ys s a an nt te er riio or r

a an nd d m me ed diia all t to o t th he e p pa ar ra ap ph ha ar ry yn ng ge ea all iin nt te er rn na all c ca ar ro ot tiid d a ar rt te er ry y..

T Th he e p pr riin nc ciip pa all o ob bs st ta ac clle es s t to o llo oc ca at te e t th he e p pa ar ra ap ph ha ar ry yn ng ge ea all iin nt te er rn na all c ca ar ro ot tiid d a ar rt te er ry y a an nd d t th he e

g gllo os so op ph ha ar ry yn ng ge ea all n ne er rv ve e a ar re e t th he e s st ty yllo op ph ha ar ry yn ng ge ea all f fa as sc ciia a a an nd d t th he e t te en ns so or r v ve ellii p pa alla at tiin nii

m mu us sc clle e.. ? ?D Diis ss se ec ct tiio on n iin n t th hiis s a ar re ea a iis s d diif fi fic cu ullt t d du ue e t to o t th he eiir r i fib br ro ou us sm mu us sc cu ulla ar r n na at tu ur re e a an nd d

a at tt ta ac ch hm me en nt ts s t to o t th he e s su ur rr ro ou un nd diin ng g s st tr ru uc ct tu ur re es s..

V Viia a a an n e en nd do os sc co op piic c e en nd do on na as sa all a ap pp pr ro oa ac ch h,, t th he e c cr ra an niia all n ne er rv ve e X X n ne er rv ve e iis s llo oc ca at te ed d b be eh hiin nd d

t th he e p pa ar ra ap ph ha ar ry yn ng ge ea all c ca ar ro ot tiid d.. C Cr ra an niia all n ne er rv ve es s X XI I a an nd d X XI II I a ar re e n no ot t e ea as siilly y m ma an niip pu ulla at te ed d d du ue e

t to o t th he e p po os st te er riio or r llo oc ca at tiio on n t to o c cr ra an niia all n ne er rv ve e X X a an nd d t to o lliim miit ta at tiio on n o of f a ac cc ce es ss s b by y t th he e

n na as sa all/ /m ma ax xiilllla ar ry y l flo oo or r.. T Th he e I IX X c cr ra an niia all n ne er rv ve e iis s llo oc ca at te ed d iin n b be et tw we ee en n iin nt te er rn na all c ca ar ro ot tiid d a ar rt te er ry y

a an nd d iin nt te er rn na all jju ug gu ulla ar r v ve eiin n,, e en nc cllo os se ed d b by y t th he e s st ty yllo op ph ha ar ry yn ng ge ea all a ap po on ne eu ur ro os siis s,, a an nd d iis s

p po ot te en nt tiia alllly y t th he e m mo os st t s su us sc ce ep pt tiib blle e n ne er rv ve e f fo or r iin njju ur ry y d du ur riin ng g a an n e en nd do on na as sa all e en nd do os sc co op piic c

a ap pp pr ro oa ac ch h t to o t th he e p po os st t- -s st ty yllo oiid d s sp pa ac ce e