Sivasubramanian, C (2022) Comprehensive study of Endoscopic Management of Primary or Secondary Involvement of Pterygopalatine Fossa in Head and Neck Pathologies. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Pterygopalatine fossa is a small inverted pyramidal shaped cul-de-sac present behind the maxillary sinus. It projects medially through the pterygo-maxillary fissure from the infratemporal fossa. It forms a space between the posterior wall of the maxillary antrum in front and the pterygoid extension of the great wing of the sphenoid behind. Medially the pterygopalatine fossa extends to the lateral wall of the nose, here formed by the vertical plate of the palatine bone, as it bridges the gap between maxilla and medial pterygoid lamina. Superiorly the vertical plate of the palatine bifurcates into a short sphenoidal process posteriorly and a larger orbital process anteriorly that, fusing with the maxilla, forms a strong bony buttress. MATERIALS AND METHODS: STUDY DESIGN: Observational cross sectional study. STUDY SETTING: The study was conducted at Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Chennai – 600003. STUDY SAMPLE: 20. ETHICAL COMMITTEE CLEARANCE: Obtained from the Institutional ethical committee. STUDY PERIOD: October 2020 to September 2021. METHOD: Patient with lesions involving PPF undergone endoscopic endonasal approach to reach the PPF. Based on the imaging and histopathological findings the endonasal approach was modified as per the need. This approach was used to do the following: 1. For comparing the extent with CT/MRI finding 2. Confirming the pathology by HPE by either biopsy or en-masse removal 3. Removal of pathologies in PPF It was also used in follow-up of the patients who were previously operated. INCLUSION CRITERIA: 1) Age group: > 12 years to < 70 years. 2) Both sex- male and female. 3) Imaging showing : a. Any soft tissue mass in the pterygopalatine fossa, b. Obliteration / Absence of fat in pterygopalatine fossa, c. Widened sphenopalatine foramen / PPF. 4) No intracranial intradural involvement. EXCLUSION CRITERIA: 1. Age group: <12 years and > 70 years. 2. Regional or systemic dissemination a. Spread to temporal fossa (laterally), b. Spread to upper pharyngeal space with or without internal carotid artery encasement (posteriorly). c. Spread to orbit, cavernous sinus & middle cranial fossa (superiorly) d. Spread to hard palate (inferiorly) 3. Patient not willing for surgery / who are not fit for surgery. MATERIAL: Patient attending UIORL with complaints of epistaxis, nasal discharge, facial pain / numbness, nasal obstruction or CT/MRI finding of involvement of PPF. They undergone EEA for disease clearance from PPF. Study was conducted in Department of UIORL, RGGGH / MMC – between. Detailed clinical history and clinical examination was done for all the 20 patients. DNE and CT-PNS with or without contrast were done in all the patients. MRI-PNS with or without MRA/MRV was done in selected patients. CONCLUSION: ❖ In our study of 20 patients with pterygopalatine fossa lesions, more number of cases are invasive mucormycosis in this pandemic of covid-19. Before Invasive mucormycosis it is Juvenile nasopharyngeal angiofibroma. ❖ Males are most commonly affected. ❖ Most common clinical presentation is facial pain and numbness followed by nasal discharge, epistaxis, nasal obstruction and facial swelling. ❖ Most common Computed tomography finding in pterygopalatine fossa mass is anterior bowing of the posterior wall of maxilla. While in invasive mucormycosis it is obliteration of retromaxillary fat / fat stranding. ❖ Different Endoscopic Endonasal approaches are used to approach the pterygopalatine fossa. The minimal procedure needed is megaantrostomy. Prelacrimal approach is used for invasive mucormycosis cases. For approaching pterygopalatine fossa in JNAs and in pterygopalatine fossa with infratemporal fossa involvement endoscopic modified denkers is the best approach as it has good surgical exploration and best instrumentation (as we remove the medial strut also). ❖ For benign lesions of pterygopalatine fossa, complete removal gives best cure rate. Well cleared pterygopalatine fossa and infratemporal fossa lesions with adjuvant therapy with Liposomal Amphotericin B have best results in invasive mucormycosis. ❖ Inspite of being a hidden area Endoscopic Endonasal approaches can be used to approach pterygopalatine fossa. Endoscopic modified denkers approach gives the best surgical exploration of pterygopalatine fossa.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221914022 |
| Uncontrolled Keywords: | Endoscopic Management, Primary, Secondary, Involvement, Pterygopalatine Fossa, Head and Neck Pathologies. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2022 15:07 |
| Last Modified: | 17 Dec 2023 07:42 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19378 |
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