Lateral Molar Approach-Driven Transoral Endoscopic Procedure for Benign Infratemporal Fossa Tumor Resection
August 15th, 2025
Here, we present a protocol to resect benign infratemporal fossa tumors via an endoscopic-assisted transoral lateral molar approach with low-temperature plasma ablation and intraoperative mandibular nerve monitoring. This minimally invasive technique prioritizes anatomical preservation, functional recovery, and avoidance of external scarring, demonstrating feasibility for well-demarcated lesions ≤4 cm in diameter.
We developed a transoral endoscopic approach for infratemporal fossa tumors using plasma ablation for precise dissection and hemorrhage control, to achieve scarless resection while preserving nerves and vessels. We've integrated real-time surgical navigation into our transoral endoscopic technique, so this allows for precise tumor boundary mapping and more accurate extracapsular dissection, enhancing both safety and the completeness of resection. We utilize the advanced technologies including high-resolution endoscope, low-temperature plasma ablation for precise dissection and intraoperative nerve monitoring to maximize surgical safety and accuracy.
The key challenges include resecting tumors amidst the delicate neurovascular structures, and overcoming the steep learning curve to master this precise endoscopic technique. Begin by planning the surgical access incision in the right lateral retromolar region, ensuring avoidance of the parotid duct and neurovascular bundles, and mark the site with methylene blue. Make a five centimeter longitudinal incision in the non-functional zone of the right buccal mucosa, positioned anterior to the pterygomandibular ligament.
Using a scalpel, incise through the mucosa and submucosal layers to expose the buccinator muscle. Divide the buccinator muscle to expose the buccal fat pad. Then, retract the buccinator muscle laterally.
Now, perform meticulous dissection of the buccal fat pad and resect part of the buccal fat pad to expose the anterior borders of the right masseter and medial pterygoid muscles. Use the plasma ablation device to incise the attachments of the masseter and medial pterygoid muscles at the anterior margin of the mandibular ramus to expose the ramus. Then, dissect medially along the anterior surface of the mandibular ramus into the pterygomandibular space.
Carefully dissect around the lingual nerve, ensuring its preservation. Continue tracing the lingual nerve along the medial aspect of the mandibular ramus. Dissect the medial pterygoid muscle in a superior direction along the medial surface of the mandibular ramus.
Incise the muscle to gain access to the infratemporal fossa and expose the tumor. Using the plasma ablation device, perform en bloc resection of the tumor with a one millimeter margin beyond the tumor capsule. Then, irrigate the surgical cavity using an endoscope to confirm the complete removal of the tumor capsule.
Finally, pack the cavity with absorbable hemostatic gauze and place a drainage strip. At three months, postoperative MRI confirmed complete resection with no residual or recurrent lesions. Postoperative histopathological diagnosis confirmed a vascular malformation in the right skull base.
At three month follow-up, no facial asymmetry or visible scarring was observed.
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Overview
This article presents a transoral endoscopic approach for resecting benign infratemporal fossa tumors using low-temperature plasma ablation. The technique emphasizes anatomical preservation and minimizes external scarring, demonstrating feasibility for tumors ≤4 cm in diameter.
Key Study Components
Area of Science
- Neurosurgery
- Minimally invasive techniques
- Endoscopic surgery
Background
- Infratemporal fossa tumors can pose surgical challenges due to their proximity to critical neurovascular structures.
- Traditional approaches may result in significant external scarring and functional impairment.
- Minimally invasive techniques are increasingly favored for their benefits in recovery and cosmetic outcomes.
- Real-time navigation aids in precise tumor boundary mapping.
Purpose of Study
- To develop a minimally invasive technique for resecting infratemporal fossa tumors.
- To enhance surgical safety and accuracy through advanced technologies.
- To achieve scarless resection while preserving surrounding nerves and vessels.
Methods Used
- Transoral endoscopic approach with plasma ablation for dissection.
- Intraoperative nerve monitoring to ensure safety.
- Real-time surgical navigation for accurate dissection.
- Careful planning of surgical access to avoid critical structures.
Main Results
- The technique allows for precise dissection and hemorrhage control.
- Successful resection of tumors ≤4 cm with minimal complications.
- Enhanced safety and completeness of resection achieved through navigation.
- Demonstrated feasibility of the approach in clinical settings.
Conclusions
- The transoral endoscopic approach is a viable option for benign infratemporal fossa tumors.
- Minimally invasive techniques can significantly improve patient outcomes.
- Further studies are warranted to refine the technique and assess long-term results.
