Aids to Undergraduate Medicine, Sixth Edition by J. L. Burton MD BSc FRCP, B. J. L. Burton MA MRCP

By J. L. Burton MD BSc FRCP, B. J. L. Burton MA MRCP

A favored and hugely revered booklet which begun the AIDS. this can be a list-type revision publication which supplies the basic evidence in an simply assimilable shape.

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4), and Kassam et al. (11) have all described an endonasal endoscopic middle turbinectomy approach to the pterygopalatine fossa that traverses the medial and posterior walls of the maxillary sinus. Kassam et al. (11) have detailed the exposure of the cavernous sinus and medial middle fossa (the quadrangular space) through this approach as well as its extension to the infratemporal fossa and lateral middle fossa. Alfieri et al. (1) have also described an endoscopic endonasal inferior turbinectomy transmaxillary approach to the pterygopalatine fossa and infratemporal fossa.

All patients received preoperative CT and/or MRI scans with contrast. Imaging was also performed immediately after surgery and annually for 5 years, then at longer intervals depending on the presence or absence of residual and/or recurrent tumor. Patients with tumors larger than 4 cm or with extensive involvement of the cavernous sinus underwent preoperative catheter angiography with or without embolization. Copies from all radiographic studies were filed for later reference. For all cases, detailed reports of operative findings were created immediately after surgery using notes, illustrations, and operative videos.

Any additional dead space within the infratemporal fossa is filled with harvested abdominal fat autograft. If an endoscopic middle meatus antrostomy is added to aid maxillary sinus drainage, a transnasal Foley catheter could be passed into the maxillary sinus and inflated to provide additional temporary tamponade to the reconstruction. NEUROSURGERY As with any endoscope-controlled cranial base approach, there is a steep learning curve with the ESTA. The limited size of the anterior maxillotomy requires significant comfort with largely one-handed dissection within the retromaxillary space and with bleeding control, especially if the cranial opening is carried posteriorly toward the pterygoid plexus.

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