Paramaxillary (Transfacial) Approach for CT-Guided Head and Neck Biopsies

Deep-seated lesions within the head and neck, such as those in the parapharyngeal space, carotid space, or skull base, present a challenge for percutaneous biopsy due to their proximity to critical neurovascular structures and difficult visualization with ultrasound. The paramaxillary approach provides a safe, reproducible, and effective CT-guided pathway to access these difficult areas.^1,2 This article demonstrates the detailed anatomy and technical considerations of using this approach. Indications, relative contraindications, and biopsy selection (fine-needle aspiration versus core biopsy) are discussed.^{2 - 4} The procedure is illustrated with case examples, highlighting the necessary anatomic landmarks, potential pitfalls, and tips for successful tissue acquisition. This technique serves as a foundational roadmap for interventional radiologists and neuroradiologists performing highly precise, low-morbidity biopsies of challenging head and neck masses. The patient whose images appear in this video article provided explicit, written consent for their use.