Endoscopic Denker's approach for resection of lesions involving the anteroinferior maxillary sinus and infratemporal fossa.

INTRODUCTION With continued advances in endoscopic techniques, recent years have witnessed significant innovation in surgical approaches to sinonasal and skull base pathology. A substantial number of open surgeries have been supplanted by endonasal procedures, and the spectrum of applications for such less-invasive methods has expanded considerably to encompass progressively larger, more complex lesions. This paradigm shift has been clearly demonstrated in surgical approaches to the maxillary sinus, where open medial maxillectomy via transfacial/sublabial incisions has given way to a potpourri of novel endoscopic surgeries and transseptal techniques. However, despite these advances, the anterolateral and anteroinferior aspects of the maxillary sinus remain difficult to reach through a purely transnasal approach and may even be inaccessible endoscopically. Current techniques for endoscopic tumor resection involve countertraction, debulking, sharp dissection, and drilling, all of which are more easily performed with straight instrumentation. Consequently, sublabial incisions with adjunctive procedures (canine fossa puncture or Caldwell-Luc) may still be necessary for surgical removal of anteriorly based maxillary pathology or lesions extending into the infratemporal fossa. This article describes the use of a novel endoscopic Denker’s approach for resection of two inverted papillomas (IP) involving the anteroinferior aspect of the maxillary sinus and infratemporal fossa, respectively. With this technique an endoscopic endonasal anterior maxillotomy is performed, obviating the need for a separate sublabial incision. The size of the maxillotomy may be adjusted according to the location of the lesion, with potential preservation of the anterosuperior alveolar nerve (ASAN). Furthermore, the entire posterior wall of the maxillary sinus can be exposed, affording access to both the pterygopalatine and infratemporal fossae.