Definition & Overview
A pterygomaxillary fossa surgery is a medical procedure performed on the pterygomaxillary fossa, which refers to a depression on both sides of the skull. The area is connected to the infratemporal region by the pterygomaxillary fissure.
Surgery performed in this area is usually due to lesions or tumours. The area is quite complex in structure. Thus, different approaches are used in performing the procedure, which is categorised under craniomaxillofacial surgery.
Who Should Undergo and Expected Results
A pterygomaxillary fossa surgery can be recommended for patients who have been diagnosed with a lesion or tumour in the said area. These tumours can be either benign or malignant. Tumours on the pterygomaxillary fossa typically originate from the soft tissues in the region, including the muscles, nerves, blood vessels, and bones. Due to the complexity of the area, tumours are not easily detected. The area is quite closely connected to the intracranial structures and the paranasal sinuses. Thus, they are only diagnosed when symptoms begin to arise. Even so, the symptoms are sometimes mistakenly attributed to other reasons.
Symptoms of tumours in the pterygomaxillary fossa include:
- Eustachian tube dysfunction
- Trismus, or spasm of the jaw muscles
- Cranial neuropathy
In addition to tumours, pterygomaxillary fossa surgery is also performed on patients who suffer from:
- Vasomotor rhinitis
- Sphenopalatine neuralgia
Pterygomaxillary fossa surgery also becomes necessary when a patient needs pterygomaxillary implants. These screw-type implants can fix a deficient maxillary bone without the need for a graft. They are helpful for patients who suffer from either partial or complete edentulism.
The complex area also makes surgery a challenge. Thus, pterygomaxillary fossa surgery is performed with careful planning and a combination of different approaches. Nowadays, one of these approaches is the endoscopic technique, which is more appropriate for palliative cases.
Pterygomaxillary fossa surgery is not recommended for everyone. Some patients who are considered not good candidates for the procedure include those with:
- Lymphoreticular tumours
- Pulmonary issues
- Cardiac problems
- Renal issues
- Disseminated disease
- Significant co-morbidities
The goal of the procedure is to excise the entire tumour. After the surgery, patients may need to undergo further cancer treatment depending on:
- Whether the tumour is malignant or benign
- The stage of the tumour, if it is found to be malignant
The success of the procedure is largely dependent on the size and location of the tumour and its proximity to the neurovascular structures in the area.
How is the Procedure Performed?
Not all pterygomaxillary fossa surgeries are performed in the same way. Researchers are developing more approaches due to the limited access to the surgical area that most existing techniques offer. Newer approaches are geared towards providing a wider field exposure of the pterygomaxillary fossa.
There is a new surgical approach used to remove most extensive tumours in the area. The surgery is performed through the following steps:
- The patient is placed under anaesthesia.
- The surgeon makes the first incision, dividing the upper lip in the midline. The incision passes through the nasal pyramid and continues in a lateral direction towards the temporomandibular joint.
- The surgeon makes another incision along the maxillary buccogingival fold. It runs from the midline to the retromolar area.
- The surgeon makes another incision that runs from the canine to the retromolar area.
- The surgeon then accesses and exposes the craniofacial skeleton before performing a frontotemporal craniotomy.
- The tumour is then exposed and resected.
- All structures are replaced, and the incisions are closed.
In another approach, the surgeon performs the following steps:
- The surgeon makes a transcervical incision combined with double osteotomies of the mandible.
- This allows the ascending ramus, the masseter muscle, and the overlying skin to reflect laterally.
- This gives the surgeon excellent access to the pterygomaxillary fossa and the base of the skull so the tumour can be removed more efficiently.
- Once the tumour is removed, the surgeon puts the ramus of the mandible back in place and fixes it with arch bars and interosseous wiring.
Possible Risks and Complications
Patients who undergo a pterygomaxillary fossa surgery face the usual risks associated with surgery. These include:
- Allergic reaction to the anaesthesia
They are also at risk of other potential complications caused by the complexity of the pterygomaxillary region. These include:
- Nerve or blood vessel damage
- Damage to other nearby structures
- Post-operative sinusitis
Despite these risks, the results of most pterygomaxillary fossa surgical procedures have been excellent, and these minor complications occur very rarely.
Jian XC, Liu JP. “A new surgical approach to extensive tumors in the pterygomaxillary fossa and the skull base.” Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Feb; 95(2): 156-62. http://www.ncbi.nlm.nih.gov/pubmed/12582354
Attia EL, Bentley KC, Head T, Mulder D. “A new external approach to the pterygomaxillary fossa and parapharyngeal space.” Head & Neck. 1984 Mar/Apr. 6(4): 884-891. http://onlinelibrary.wiley.com/doi/10.1002/hed.2890060414/full
What is Pterygomaxillary Fossa Surgery: Overview, Benefits, and Expected Results
When it comes to surgical procedures, one that may not be as well-known is Pterygomaxillary Fossa Surgery. This complex and specialized surgery focuses on treating specific conditions in the Pterygomaxillary Fossa, a space located behind your cheekbone. In this article, we will explore the details of Pterygomaxillary Fossa Surgery, including its overview, benefits, and what you can expect from the procedure.
Understanding Pterygomaxillary Fossa
Before diving into the surgery itself, it’s important to have a clear understanding of what the Pterygomaxillary Fossa is and its significance. The Pterygomaxillary Fossa is a small space located deep within your skull, behind the maxilla or upper jawbone and the pterygoid process of the sphenoid bone. It serves as an anatomical pathway for important structures, such as the maxillary artery and the posterior superior alveolar nerve, which supply blood and sensation to the upper teeth, respectively.
What is Pterygomaxillary Fossa Surgery?
Pterygomaxillary Fossa Surgery, also known as Pterygomaxillary Fossa Decompression, is a complex surgical procedure that aims to address various conditions within the Pterygomaxillary Fossa. It involves creating an opening or decompression within the fossa to alleviate pressure or entrapment of structures within.
Common Conditions Treated
Pterygomaxillary Fossa Surgery is primarily performed to address specific conditions, including:
1. Pterygomaxillary Fossa Entrapment: In some cases, anatomical structures may become entrapped or compressed within the Pterygomaxillary Fossa, causing pain and discomfort. Surgery can release this entrapment and provide relief.
2. Maxillary Artery Pathology: Certain pathologies, such as arteriovenous malformations or aneurysms, can affect the maxillary artery within the Pterygomaxillary Fossa. Surgery can help treat and manage these conditions.
3. Tumors: Pterygomaxillary Fossa tumors can cause various symptoms and require surgical intervention. Pterygomaxillary Fossa Surgery allows for the removal of these tumors and addresses any associated complications.
The Surgical Procedure
Pterygomaxillary Fossa Surgery is typically performed by an oral and maxillofacial surgeon or a neurosurgeon. The procedure may require general anesthesia, ensuring patient comfort throughout the surgical process.
During the surgery, an incision is made either externally through the cheek or endoscopically through the nasal cavity. The surgeon then accesses the Pterygomaxillary Fossa and carefully decompresses the fossa by removing bone or other structures that may be causing compression or entrapment.
The specific approach and techniques used in Pterygomaxillary Fossa Surgery can vary based on the patient’s condition and the surgeon’s expertise. This individualized approach ensures the best possible outcome for each patient.
Benefits of Pterygomaxillary Fossa Surgery
Pterygomaxillary Fossa Surgery offers several benefits, including:
1. Pain Relief: The surgery can alleviate pain and discomfort caused by the entrapment or compression of important anatomical structures within the Pterygomaxillary Fossa.
2. Improved Blood Flow: By decompressing the maxillary artery and addressing any underlying pathologies, Pterygomaxillary Fossa Surgery improves blood flow to the upper teeth and surrounding structures, promoting healthy tissue function.
3. Tumor Removal: When performed to remove tumors, Pterygomaxillary Fossa Surgery can effectively eliminate cancerous or benign growths, preventing further complications and improving overall health.
4. Enhanced Quality of Life: By addressing the underlying conditions within the Pterygomaxillary Fossa, this surgery can significantly improve a patient’s quality of life by relieving pain, restoring normal blood flow, and treating tumors.
Expected Results and Recovery
After Pterygomaxillary Fossa Surgery, patients may experience immediate relief from pain and improved function. However, it’s important to note that the full benefits of the surgery may take some time to manifest, and individual results may vary.
The recovery period will depend on the complexity of the surgery and the patient’s overall health. The surgeon will provide specific guidelines for post-operative care and pain management. Patients are typically advised to refrain from strenuous activities and follow a soft food diet during the initial healing phase.
Long-term follow-up appointments will be scheduled to monitor the patient’s progress and ensure optimal healing. Adhering to these appointments is crucial for a successful recovery.
In summary, Pterygomaxillary Fossa Surgery is a specialized procedure that focuses on addressing various conditions within the Pterygomaxillary Fossa. By decompressing the fossa, the surgery provides numerous benefits, including pain relief, improved blood flow, tumor removal, and a better quality of life for patients. If you are experiencing symptoms related to the Pterygomaxillary Fossa or have been diagnosed with a condition that may require surgery, consulting with a qualified oral and maxillofacial surgeon or neurosurgeon is essential. They can assess your individual case and provide the appropriate treatment plan to improve your overall health and well-being.