{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T15:54:33Z","timestamp":1770566073272,"version":"3.49.0"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T00:00:00Z","timestamp":1541635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To evaluate the potential of a minimally invasive transoral\u2013transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Cadaver study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five cadaveric specimens were dissected raising an inverted U\u2010shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross\u2010court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm<jats:sup>2<\/jats:sup> vs. 312.76 mm<jats:sup>2<\/jats:sup>, <jats:italic>P<\/jats:italic> &lt;.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm<jats:sup>3<\/jats:sup> vs. 138.91 mm<jats:sup>3<\/jats:sup>, <jats:italic>P<\/jats:italic> &lt; .005). MITA also offered greater angles of approach for all targets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA <jats:italic>Laryngoscope<\/jats:italic>, 129:339\u2013343, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27469","type":"journal-article","created":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T19:51:24Z","timestamp":1541706684000},"page":"339-343","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Modified endoscopic endonasal approach with a minimally invasive transoral approach\u2014an adjunct to infrapetrous approaches"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3931-3544","authenticated-orcid":false,"given":"Guillermo","family":"Maza","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali M. Moustafa","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Somasundram","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley A.","family":"Otto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."},{"name":"Department of Neurosurgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."},{"name":"Department of Neurosurgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo L.","family":"Carrau","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."},{"name":"Department of Neurosurgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20027"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2005.19.1.7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1564057"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2013.02.003"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1312706"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.2.JNS131773"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1395267"},{"key":"e_1_2_7_9_1","first-page":"441","article-title":"History of endonasal skull base surgery","volume":"60","author":"Wang AJ","year":"2016","journal-title":"J Neurosurg Sci"},{"key":"e_1_2_7_10_1","first-page":"361","article-title":"Bullet located between the atlas and the base of the skull: technique of removal through the mouth","volume":"1","author":"Kanavel AB","year":"1917","journal-title":"Surg Clin Chicago"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1966.24.2.0536"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-197110000-00007"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01405143"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-008-0599-3"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24034"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100108126"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.st.2014-0135"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-994288"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1997.87.5.0677"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.3171\/2013.2.PEDS12231"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1358374"},{"key":"e_1_2_7_22_1","first-page":"169","article-title":"Usefulness of neuroendoscopy and a neuronavigator for removal of clival chordoma [in Japanese]","volume":"26","author":"Miyagi A","year":"1998","journal-title":"No Shinkei Geka"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajot.2002.126324"},{"issue":"3","key":"e_1_2_7_24_1","first-page":"266","article-title":"Transpalatal endoscopic endonasal resection of a giant epignathus skull base teratoma in a newborn. 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