Introduction

Surgeons often find total maxillectomy challenging due to the complex anatomy of the pterygomaxillary junction. However, a recent technical note describes a novel approach for endoscopic pterygoid process resection that avoids breaching the maxillary sinus. This sinus-sparing method utilizes two specific transnasal techniques to achieve detachment while maintaining anatomical integrity.

Advancements in Endoscopic Pterygoid Process Resection

Firstly, the surgical procedure involves a lower cut at the level of the nasal floor. Secondly, surgeons perform an upper cut positioned specifically below the vidian canal. Consequently, this method allows for direct visualization of the posterior maxillary osteotomy. Furthermore, this technique facilitates a precise assessment of the posterior margins during the operation. Therefore, clinicians can keep the tumor within an intact maxillary sinus compartment. This containment potentially reduces the risk of local recurrence and enhances oncological safety.

Clinical Benefits and Visualization

Moreover, cadaveric dissections have confirmed the feasibility and safety of this approach. In addition to improved visualization, the technique avoids unnecessary trauma to the sinus mucosa. Thus, the integrity of the sinus remains preserved throughout the surgical process. Finally, clinical cases demonstrate that this technique effectively manages the pterygomaxillary junction without traditional complications. Ultimately, this advancement provides a refined tool for surgeons performing complex head and neck resections.

FAQs

What is the primary benefit of avoiding a maxillary sinus breach?

Preserving the sinus integrity helps maintain the tumor within an intact compartment. This facilitates better visualization and more accurate margin assessment during the resection.

Where are the surgical cuts positioned in this technique?

The technique requires a lower cut at the level of the nasal floor and an upper cut placed carefully below the vidian canal.

Does this technique provide better visualization than traditional methods?

Yes, this approach enables direct visualization of the posterior maxillary osteotomy. Such visibility is often difficult to achieve through conventional open or endoscopic surgery.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider for any medical condition. Refer to the latest local and national guidelines for clinical practice.

References

• Conti C et al. Endoscopic Pterygoid Process Resection Without Maxillary Sinus Breach in Total Maxillectomy. Laryngoscope. 2026 Jun 17. doi: 10.1002/lary.70685. PMID: 42308005.


• Nagaoka M et al. Endoscopic Total Maxillectomy Without Facial Skin Incision. Laryngoscope. 2025 Jan;135(1):124-129. doi: 10.1002/lary.31685.


• Hanazawa T et al. Endoscopic contralateral transmaxillary approach for pterygoid process osteotomy in total maxillectomy: A technical case report. Auris Nasus Larynx. 2018 Jun;45(3):611-615. doi: 10.1016/j.anl.2017.07.007.