TRANSORAL LIGATION OF MAXILLARY ARTERY IN THE RETROMANDIBULAR FOSSA: A NOVEL ENDOSCOPIC TECHNIQUE
1Acibadem University Faculty of Medicine, Department of Otorhinolaryngology, İstanbul, Türkiye2Ankara University Fakülte of Medicine, Department of Otorhinolaryngology, Ankara, Türkiye Objective: To introduce a novel transoral endoscopic technique for ligating the maxillary artery (MA) in the retromandibular fossa as an alternative approach for intraoperative bleeding control in juvenile nasopharyngeal angiofibroma (JNA) surgeries.
Methods: An anatomical study was conducted using two formalin-fixed cadaveric heads (four sides) with a 4 mm 0° rigid endoscope. An intraoral mucoperiosteal incision was placed on the retromolar trigon. The outer surface of the ramus from the angle to the neck of the condyle was exposed by retracting the buccal region and the masseter muscle. The retromandibular fossa was opened by incising the mandibular periosteum along the posterior border of the ramus. The MA and superficial temporal artery were identified in the parotid gland and the MA was clipped. The technique was subsequently applied in three clinical cases of JNA.
Results: In cadaveric dissections, the transoral retromandibular approach provided clear identification and successful ligation of the MA. In clinical cases, the method achieved effective bleeding control, with no significant blood transfusions required and no perioperative complications observed. All patients experienced successful tumor resections, and follow-up revealed no recurrences or adverse events.
Conclusion: The transoral endoscopic ligation of the MA in the retromandibular fossa is an effective technique for controlling intraoperative bleeding in JNA surgery. This approach can be considered in cases where traditional methods are inadequate or contraindicated and may serve as an adjunct to preoperative embolization or as an independent strategy.
Keywords : Angiofibroma; embolization; hemorrhage; maxillary artery