Endoscopic anatomy of the pterygopalatine fossa

Traditional approaches to the pterygopalatine fossa have required invasive techniques that result in significant patient morbidity. The advent of endoscopic endonasal surgery overcomes many of the limitations needed to reach the relatively inaccessible pterygopalatine fossa. We describe our endoscopic technique to access this region, particularly noting the neurovascular anatomy encountered intraoperatively. A medial-to-lateral dissection to approach the pterygopalatine fossa appears to be simpler to perform and offers shorter operating times when compared with a lateral-to-medial approach. Careful dissection of the greater palatine nerve from its bony canal allows its lateral mobilization, and minimizes potential injury and postoperative palatal hypesthesia. Sacrifice of the vidian nerve may result in minimal deficits.