Clinical study of the removal of infratemporal fossa and pterygopalatine fossa foreign bodies using a trans-oral approach

To summarize the clinical experience of removing infratemporal fossa and pterygopalatine fossa foreign bodies via a trans-oral approach.

The clinical data of 9 patients with foreign bodies in the infratemporal fossa and pterygopalatine fossa hospitalized from March 2008 to June 2017 were analyzed retrospectively. Among these cases, 4 were flying injuries, 2 were falling injuries, 2 were traffic injuries and 1 was an iatrogenic syringe injury. Foreign bodies were divided into the following categories: 3 cases of wood from branches, 3 cases of iron filings, 2 cases of broken glass, and one case of a broken syringe needle. Before surgery, all subjects underwent spiral CT three-dimensional reconstruction and CT angiography examinations. After accurately determining the relationship between the foreign body and the internal and external carotid arteries and their branches, patients underwent an operation under general anesthesia to remove the foreign body via a trans-oral approach. In addition, patients participated in mouth opening training for one week. Then, patients were followed for 1 to 6 months.

Foreign bodies were removed completely in all 9 patients. Foreign bodies were independently located in the pterygopalatine fossa in 2 cases and in the in fratemporal fossa in 3 cases. There were 4 cases of foreign bodies located in both the infratemporal fossa and the pterygopalatine fossa. All 9 patients had the foreign bodies completely removed and were discharged one week after surgery. They were followed for 1 to 6 months. Their mouth opening and occlusion were normal, without any complications.

Spiral CT, 3D reconstruction and CT angiography examinations are necessary and important for accurate pre-operation positioning. It is feasible to remove foreign bodies in the infratemporal fossa and pterygopalatine fossa via a trans-oral approach.