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1. Battaglia P, et al. Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors. Otolaryngol Head Neck Surg. 2014;150(4):696-702. 2. Youssef A, et al. Endoscopic vs Open Approach to the Infratemporal Fossa: A Cadaver Study. J Neurol Surg B Skull Base. 2015;76(5):358-364. 3. Taylor RJ, et al. Endoscopic endonasal approaches to infratemporal fossa tumors: a classification system and case series. Laryngoscope. 2014;124(11):2443-2450. 4. Van Rompaey J, et al. Access to the parapharyngeal space: an anatomical study comparing the endoscopic and open approaches. Laryngoscope. 2013;123(10):2378-2382. 5. Boyce BJ, et al. Transoral robotic approach to parapharyngeal space tumors: Case series and technical limitations. Laryngoscope. 2016;126(8):1776-1782. 6. Carrau RL, et al. Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base. Head Neck. 2013;35(11):E351-358. References The infratemporal fossa (ITF) is a challenging area to access due to its deep location and complex anatomy. Traditionally, open approaches have been utilized in accessing this space. While these approaches offer wide visualization, they often involve more extensive resection and increased cosmetic morbidity.1,2 Recently, with the advent of endoscopic and robotic (TORS) techniques, both endoscopic endonasal (EEA) and transoral approaches to the ITF have garnered favorability as they can improve functional and cosmetic outcomes.3,4,5 However, these benefits come at the consequence of visualization and maneuverability, increasing the risk for hemorrhage and capsular disruption. In addition, because of the complexity of these approaches, the operative time may also be longer and there remains the possibility that conversion to an open procedure will be necessary.1,4,5 In 2012, a study using cadaveric models to investigate the feasibility of a combined TORS and EEA approach to skull base lesions found that the two approaches can be complementary in providing wide exposure of the ITF, while minimizing morbidity.6 In our case report, we describe a novel surgical approach to the ITF with a combined endonasal transpterygoid approach and endoscopic intraoral approach in a patient with a transpatial lesion of the infratemporal and masticator space. Introduction

journal of neurological surgery. part b, skull base

Combined Endoscopic Endonasal and Transoral Approach to Transpatial Lesion Involving the Masticator, Preparotid, and Infratemporal Spaces: A Case Study