Approaches to the pterygopalatine space—Caldwell-Luc and beyond

Before the development of endoscopic skull-based surgical techniques, external surgical approaches with facial incisions often were used to access lesions of the pterygopalatine space (PPS) and beyond. Lesions of the PPS and adjacent skull base areas include juvenile nasal angiofibromas, schwannomas, lymphoma, fungal infections, cerebrospinal fluid (CSF) leaks, and metastatic malignancies. Traditional approaches included midface degloving, lateral rhinotomy with medial maxillectomy, Caldwell-Luc, and subtemporal craniotomy. Recent advances in endoscopic technology, endoscopic instrumentation, and stereotactic navigation have markedly augmented minimally invasive approaches for these pathologies.