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The Intermaxillary-Mandibular Approach to the Post-Styloid Parapharyngeal Space: An Anatomic Study.

Sophia Dang1, Anthony Tang2, Gianluca Lorenzo Fabozzi3

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

The Laryngoscope
|November 3, 2025
PubMed
Summary

The novel intermaxillary-mandibular (IMM) approach offers superior visualization and access to the parapharyngeal internal carotid artery (ppICA) in the upper parapharyngeal space (UPPS). This technique improves surgical safety and efficacy for complex parapharyngeal space lesions.

Keywords:
anatomical studyinternal carotid arteryparapharyngeal spaceskull basesurgical approaches

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Area of Science:

  • Neurosurgery
  • Head and Neck Surgery
  • Surgical Anatomy

Background:

  • Parapharyngeal space (PPS) lesions pose surgical challenges, particularly concerning the parapharyngeal internal carotid artery (ppICA).
  • Existing surgical approaches often provide limited visualization and access to the PPS and ppICA, leading to potential complications.

Purpose of the Study:

  • To investigate and compare a novel intermaxillary-mandibular (IMM) surgical approach with traditional methods for accessing the PPS and ppICA.
  • To evaluate the visualization and access capabilities of the IMM approach for the ppICA at the skull base.

Main Methods:

  • Anatomical study involving endoscopic dissections of the IMM approach and traditional transcervical/transparotid (TCTP) approach in cadaver heads.
  • Qualitative assessment and comparison of visualization, access, and potential risks associated with both surgical techniques.

Main Results:

  • The IMM approach allows complete mobilization of the ppICA as it enters the skull base in the upper PPS (UPPS).
  • Compared to TCTP approaches, the IMM approach offers enhanced ppICA visualization, reduced risk of facial nerve injury, and more direct access.
  • The surgical corridor length (SCL) was significantly shorter with the IMM approach (50.2 mm) versus TCTP (63.5 mm).

Conclusions:

  • Surgical access to the PPS, especially for lesions involving the ppICA, is hindered by anatomical constraints.
  • The novel IMM approach provides comprehensive access to the UPPS and facilitates complete ppICA mobilization.
  • This technique is crucial for optimizing safe surgical intervention in complex PPS and ppICA pathologies.