Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa.

Selecting an appropriate surgical approach for resection of huge skull base tumors involving pterygopalatine and infratemporal fossa is challenging because of their rarity and high possibility of vital anatomical structure injuries. To suggest the guidance of selecting the appropriate approach by analyzing outcomes and satisfactions of known surgical approaches with our previous experience, the authors retrospectively analyzed skull base tumor cases experienced for 24 years, and condensed to 4 well-known surgical approaches: maxillary swing, infratemporal fossa type C, transzygomatic, and a combined transzygomatic-midfacial degloving approach: to review indications, advantages, and limitations of these approaches. Maxillary swing approach was useful in large-sized tumors as it provided wide surgical field; however, inevitable facial scar was the main drawbacks, especially in adolescents. Infratemporal fossa approach type C was helpful in the involvement of vital vascular structures; however, long incision scar with temporal area depression and permanent conductive hearing loss were the factors of patients' dissatisfaction. Transzygomatic approach could be the good alternative to the infratemporal fossa approach type C; however, en bloc tumor resection was impossible due to its limited operative space. To overcome limitations of these approaches, transzygomatic approach was combined with midfacial degloving approach, and it enabled lateral and anterior access without prominent facial scar and/or deformity while providing wide surgical space. Based on our 24 years of surgical experience in managing huge skull base tumors, the authors recommend the combined transzygomatic-midfacial degloving approach, which enables complete resection with short postoperative healing periods and no disfiguring facial incisions.

Radiological comparison of inferior turbinate hypertrophy between allergic and non-allergic rhinitis: does allergy really augment turbinate hypertrophy?

BACKGROUND: Inferior turbinate hypertrophy could be a result of allergic rhinitis (AR) that leads to nasal congestion and nasal airway obstruction, which is the most bothersome complaint in patients with AR. However, evidence regarding whether patients with AR have a more hypertrophied inferior turbinate than do patients with non-AR is lacking. OBJECTIVE: We aimed to evaluate the degree of inferior turbinate hypertrophy according to the presence of AR using radiological measurements of the inferior turbinate. METHODS: For evaluating the inferior turbinate, which contributes to nasal obstruction in patients with AR, we enrolled 90 adult patients with septal deviation and divided them into two groups (AR group: n = 49; non-AR group: n = 41). Allergic rhinitis was diagnosed according to the presence of an allergic history, positive multiple allergen simultaneous test, and serological total immunoglobulin E level (≥ 100 kU/L). We analyzed the minimal cross-sectional area on acoustic rhinometry for both groups. The bilateral total width as well as medial mucosa and nasal cavity space in the anterior and posterior portions of the inferior turbinate were measured using computed tomography. RESULTS: We could not find any significant differences in the anterior and posterior dimensions of the inferior turbinate, intranasal space, and choanal spaces between the AR and non-AR groups. Instead, the anterior part of the inferior turbinate in both the groups showed significant differences between the deviated and contralateral sides. The contralateral side had a larger width than did the deviated side, but no significant difference was noted in the posterior portion of the inferior turbinate. CONCLUSION: The degree of inferior turbinate hypertrophy showed no difference between patients with and without AR. Therefore, we suggest that surgical treatment for reducing the size of the inferior turbinate hypertrophy should be considered when performing septoplasty in patients with symptoms of nasal obstruction, regardless of the presence of AR.