Endoscopic Endonasal Transturbinate Approach to the Pterygopalatine Fossa in the Management of Juvenile Nasopharyngeal Angiofibromas
Figure 2
Preoperative (a), intraoperative (b), (c), (d), (e), and (f), postoperative endoscopic views (g), and macroscopic features of the excised tumor (h). (a) The tumor is filled in the posterior part of the right nasal cavity. (b) Submucous inferior turbinoplasty provides improved visualization and accessibility to the tumor. (c) Maxillary sinus is opened, and the mucosa is elevated from the posterior wall of the sinus. (d) The posterior wall bone of maxillary sinus is then removed, and the PPF is widely exposed endoscopically. (e) and (f) Internal maxillary artery and sphenopalatine artery are identified in the PPF and are ligated with a hemoclip. (g) and (h) The tumor is removed in en bloc from the nasal cavity. IT: inferior turbinate; MT: middle turbinate; NS: nasal septum; Tm: tumor; SPF: sphenopalatine foramen; PPF: pterygopalatine fossa; MS: maxillary sinus; IMA: internal maxillary artery; SPA: sphenopalatine artery. Black arrows: hemoclip, white arrows: sphenoid sinus.
