Transpalatal approach to deeper cranial structures

The approach to deep midline cranial structures is technically difficult. The transpalatal approach has a relatively wide exposure as compared to the transnasal, transantral and transethmoidal approches. The added advantage of a medial approach which follows medial landmarks and the flexibility of being able to extend exposure to the maxillary sinuses and pterygomaxillary space makes this an attractive approach for large lesions in the nasal passages, nasopharynx and sphenoid sinuses. Large mucoperiosteal flaps, care to avoid the palatine vessels, and application of palatal splint postoperatively, minimize complications and patient discomfort. The authors have used this approach to repair nasopharyngeal atresia, remove nasopharyngeal angiofibromas, approach the pituitary, craniopharyngioma and isolated sphenoid sinus opacification as well as sphenoid sinusitis with cavernous sinus thrombosis.