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Updated: Aug 29, 2025

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Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video.

Gerardo Guinto1,2, Eli Hernandez2, David Gallardo-Ceja2

  • 1Department of Neurosurgery, Centro Medico ABC, Mexico DF, Mexico.

Journal of Neurological Surgery. Part B, Skull Base
|September 7, 2022
PubMed
Summary
This summary is machine-generated.

The zygomatic-transmandibular approach (ZTMA) offers safe and effective surgical access for large tumors in the infratemporal fossa (ITF) and parapharyngeal space (PPS). This method ensures excellent cosmetic outcomes and preserves crucial nerve functions.

Keywords:
infratemporal fossaparapharyngeal spaceskull base surgerytrigeminal schwannomazygomatic-transmandibular approach

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Area of Science:

  • Neurosurgery
  • Head and Neck Surgery
  • Surgical Oncology

Background:

  • Tumors in the infratemporal fossa (ITF) and parapharyngeal space (PPS) often grow large due to slow development and subtle symptoms.
  • Large tumors necessitate extensive surgical approaches for complete resection.

Purpose of the Study:

  • To describe the zygomatic-transmandibular approach (ZTMA) for accessing the ITF and PPS.
  • To demonstrate the efficacy of ZTMA in resecting a trigeminal schwannoma.

Main Methods:

  • The zygomatic-transmandibular approach (ZTMA) combines pterional craniotomy and zygomatic-mandibular osteotomy.
  • Multidisciplinary tumor excision involving neurosurgical and head and neck teams.

Main Results:

  • ZTMA provides ample and safe exposure of the ITF and PPS.
  • Successful resection of a trigeminal schwannoma was achieved using ZTMA.
  • The approach preserved facial and chewing nerve function with excellent cosmetic results.

Conclusions:

  • ZTMA is a reliable surgical option for large tumors in the ITF and PPS.
  • This approach offers significant advantages in terms of safety, functional preservation, and aesthetics.