Related Experiment Video
Updated: Sep 8, 2025
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Comparison of the Orbitozygomatic and Transmandibular Approaches to the Infratemporal Fossa
Levent Aydin1, Tufan Agah Kartum2, Adem Yilmaz3
1Department of Neurosurgery, Medicana International Istanbul Hospital, Istanbul, Turkey; Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
Objective:
The infratemporal fossa (ITF) represents a complex anatomical region of critical relevance in skull base surgery, particularly due to its involvement in the extension of neoplastic lesions. Surgical access to this region remains technically demanding. The orbitozygomatic (OZ) and transmandibular (TM) approaches offer distinct anatomical perspectives and operative corridors. This study aimed to anatomically compare these two techniques to delineate their microsurgical fields, advantages, and limitations in accessing the ITF.
Material And Methods:
A total of five silicone-injected, formalin-fixed cadaveric heads (10 sides) were dissected using surgical microscopes at magnifications ranging from ×6 to ×40. A standard OZ craniotomy was performed, followed by progressive drilling of the middle cranial fossa and resection of the greater sphenoid wing to expose the ITF. Subsequently, the TM approach was performed on the same cadavers to evaluate its added exposure. Anatomical landmarks, neurovascular structures, and spatial relationships were meticulously documented and compared across approaches.
Results:
The OZ approach enabled wide exposure of the anterior and middle ITF, particularly through the anterolateral triangle and foramina of the middle fossa with minimal brain retraction. However, access to the posterior ITF, maxillary artery, and lower cranial nerves was limited. The TM approach, conversely, provided extended visualization of the middle and posterior ITF, superior control of the maxillary artery, and exposure of deep neurovascular structures, including the internal carotid artery and cranial nerves IX-XII. Integration of both approaches offered a complementary panoramic view of the ITF.
Conclusions:
The OZ approach is optimal for anterior and middle ITF lesions with orbital or cavernous sinus extension, while the TM approach is more effective for posterior ITF pathologies requiring wider vascular and neural access. Combining both strategies may offer a tailored approach for complex skull base surgeries involving the ITF.
Related Concept Videos
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:27Cranial Bones: Lateral View
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...