E-ISSN: 1019-5157
ISSN: 2651-5024
Research
ANATOMICAL LANDMARKS AND BOUNDARIES OF THE ENDOSCOPIC SUBLABIAL TRANSMAXILLARY APPROACH TO THE MIDDLE CRANIAL FOSSA: A CADAVERIC STUDY
Ebubekir Akpınar✉ ,
Aysu İyigün Kabakcı ,
Hasan Çağrı Postuk ,
Ercan Boşnak ,
Akın Akakın ,
Abuzer Güngör ,
Türker Kılıç ,
Bekir Tuğcu
Aysu İyigün Kabakcı ,
Hasan Çağrı Postuk ,
Ercan Boşnak ,
Akın Akakın ,
Abuzer Güngör ,
Türker Kılıç ,
Bekir Tuğcu
Department of Neurosurgery, Republic of Türkiye, Ministry of Health Ankara Etlik Şehir Hastanesi, Ankara, Türkiye; Department of Neurosurgery, Istinye University; Neurosurgery, University Of Health Sciences, Başakşehir Çam And Sakura City Hospital
Accepted: 07/08/2026
Article in Press
Corresponding Author:
Ebubekir Akpınar (akpinarebubekir@gmail.com)
Abstract
Aim
Almost all approaches to middle cranial fossa pathologies are performed with transcranial approaches. Studies on the endoscopic approach to this region are gaining popularity over time. In this study, we aimed to demonstrate the anatomical framework of the endoscopic sublabial transmaxillary approach (ESTA) to the middle cranial fossa.
Material and Methods
Six formalin fixed red and blue silicon injected human cadaveric heads were used for endoscopic dissections to define surgical landmarks and limits of the ESTA. Photos were taken with 4K high-definition camera, microscope and video monitor endoscopy systems.
Results
To reach middle cranial fossa via ESTA includes; A sublabial mucosal dissection, drilling maxillary sinus anterior wall, removing mucosa of maxillary sinus while preserving infraorbital nerve, opening posterior wall of the maxillary sinus (limited medially with infraorbital nerve), drilling lateral pterygoid process, mobilize and retracting the upper head of lateral pterygoid muscle and temporal muscle, definition foramen rotundum and foramen ovale with following maxillary nerve and mandibular nerve, drilling sphenoid bone (limited medially with vertical line from foramen ovale inferiorly with horizontal line from foramen rotundum) and reaching temporal pole with opening dura mater. ESTA was found to be at a statistically shorter distance from the middle cranial fossa compared to the endonasal transmaxillary approach(p<0.001).
Conclusion
Middle cranial fossa is accessible via sublabial transmaxillary approach by using endoscope while preserving neurovasculer structures. This approach provides direct access to the temporal pole without craniotomy and parenchyma retraction, as an alternative to transcranial approaches.
Almost all approaches to middle cranial fossa pathologies are performed with transcranial approaches. Studies on the endoscopic approach to this region are gaining popularity over time. In this study, we aimed to demonstrate the anatomical framework of the endoscopic sublabial transmaxillary approach (ESTA) to the middle cranial fossa.
Material and Methods
Six formalin fixed red and blue silicon injected human cadaveric heads were used for endoscopic dissections to define surgical landmarks and limits of the ESTA. Photos were taken with 4K high-definition camera, microscope and video monitor endoscopy systems.
Results
To reach middle cranial fossa via ESTA includes; A sublabial mucosal dissection, drilling maxillary sinus anterior wall, removing mucosa of maxillary sinus while preserving infraorbital nerve, opening posterior wall of the maxillary sinus (limited medially with infraorbital nerve), drilling lateral pterygoid process, mobilize and retracting the upper head of lateral pterygoid muscle and temporal muscle, definition foramen rotundum and foramen ovale with following maxillary nerve and mandibular nerve, drilling sphenoid bone (limited medially with vertical line from foramen ovale inferiorly with horizontal line from foramen rotundum) and reaching temporal pole with opening dura mater. ESTA was found to be at a statistically shorter distance from the middle cranial fossa compared to the endonasal transmaxillary approach(p<0.001).
Conclusion
Middle cranial fossa is accessible via sublabial transmaxillary approach by using endoscope while preserving neurovasculer structures. This approach provides direct access to the temporal pole without craniotomy and parenchyma retraction, as an alternative to transcranial approaches.
Keywords
endoscopic sublabial approach
middle cranial fossa
skull base
transmaxillary approach