Endoscopic transmaxillary biopsy of pterygopalatine space masses: A preliminary report

Introduction: Although masses in the pterygomaxillary space are uncommon, they frequently present diagnostic challenges when they occur. If a tissue biopsy is required for pathological analysis, the relative inaccessibility of this region can make the surgical approach more extensive and technically difficult than seems justified. In this study, we describe a series of four cases in which a transnasal endoscopic technique was used to biopsy masses of the pterygomaxillary space. Methods: The four patients described in this report had lesions of the pterygomaxillary space that were detected radiographically. The surgical approach involved an endoscopic uncinectomy and a wide maxillary antrostomy to provide maximum exposure of the posterior maxillary sinus wall. Careful opening of the bone and underlying periosteum provided ready access to the pterygomaxillary space in an atraumatic fashion. Biopsy specimens were taken under direct endoscopic visualization using traditional biopsy forceps. Results: In each case, satisfactory exposure of the mass was achieved and diagnostic biopsy specimens were obtained. There were no adverse sequelae related to the procedure. One patient was returned to the operating room 2 weeks later for a repeat biopsy so that additional diagnostic studies could be performed. This was obtained easily through the previous antrostomy and posterior maxillary wall opening. Conclusions: The transnasal endoscopic approach to the pterygomaxillary space is a safe, relatively noninvasive technique that can be performed by otolaryngologists trained in endoscopic sinus surgery. This procedure allows adequate exposure of the pterygomaxillary space for biopsy while avoiding the morbidity of an open surgical approach.