Objective In this study,we aimed to evaluate the feasibility of the operative method,indications,and clinical outcomes of the endoscopic prelacrimal recess-transpterygoid approach for treating lesions in the upper parapharyngeal space.Methods We retrospectively analyzed 10 cases of upper parapharyngeal space lesions between February 2016 and August 2021.Enhanced MRI and CT scans were performed before surgery.All the patients underwent endoscopic surgery,during which the pterygoid process was exposed by removing the anterior and medial walls and soft tissues in the pterygopalatine fossa through a prelacrimal-recess approach.Furthermore,using the eustachian tube,musculus palatosalpingeus,medial pterygoid muscle,and lateral pterygoid plate as reference marks,lesions in the upper parapharyngeal space were removed under image-navigation-assisted endoscopic surgery.A week after the surgery,enhanced MRI reinspection was performed to assess the characteristics,complications,and surgical outcomes.Results All patients'lesions were fully exposed by endoscopic prelacrimal-recess-transpterygoid approach.Among the ten cases,three cases of cavernous hemangioma,two cases of lymphoma,four cases of inflammation/inflammatory pseudotumor,and one case of nasopharyngeal carcinoma were confirmed through histopathological and immunohistochemical examination.Among these,all cavernous hemangiomas were totally removed,whereas lymphomas,and inflammation/inflammatory pseudotumors,naso-pharyngeal carcinoma were subtotally removed after surgery.During the post-surgery follow-up period of 6-28 months,all the cases of hemangioma exhibited no recurrence,lymphoma cases exhibited complete remission after chemotherapy,inflammation/inflamma-tory pseudotumor cases exhibited no significant change compared with their post-surgery condition,and nasopharyngeal carcinoma case exhibited complete remission of nasopharyngeal disease after radiotherapy.Additionally,postoperative hard palate numbness on the affected side occurred in all 10 patients,four cases of hard palate numbness exhibited no remission.Conclusion The endoscopic prelacrimal-recess-transpterygoid approach effectively exposed the upper parapharyngeal space.The eustachian tube,musculus pala-tosalpingeus,medial pterygoid muscle,and medial pterygoid plate can be used as anatomical reference marks in this area to facilitate removal of lesions while protecting vital structures of the skull base.This approach is advantageous for the removal of lesions located in the upper parapharyngeal space.
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