CT indicated that a tumor had spread into the left sphenoid sinus, pterygopalatine fossa, pterygomaxillary
fissure, and infratemporal fossa (figure 4, A).
The posterolateral wall of the antrum was then removed, leaving the maxillary sinus, nasal cavity, pterygopalatine fossa, and nasopharynx as a single large cavity that communicated with the infratemporal fossa through the narrow pterygomaxillary
CT findings included complete opacification of the left maxillary sinus, inward retraction and thinning of all sinus walls, enophthalmos, increased orbital volume, occlusion of the maxillary sinus infundibulum, an enlarged middle meatus with lateral retraction of the middle turbinate, and an increase in pterygomaxillary
fossa adipose tissue (figure 2).
The mass also extended into the right masticator space through the pterygomaxillary
The parapharyngeal space--also known as the pharyngomaxillary, pterygomaxillary
, lateral pharyngeal, and pterygopharyngeal space--is a potential space filled with connective tissue.
Fat in the pterygomaxillary
space filled the lateral pterygoid process opening, and the posterior maxillary wall remucosalized in a few weeks (figure 5).
The patient was taken to an emergency department, where plain film radiography detected the nail in the left pterygomaxillary
If the trocar enters the pterygomaxillary
space, it could damage the internal maxillary artery, the infraorbital nerve, or branches of the trigeminal nerve.
An oscillating bone saw is then used to make maxillary osteotomies at the Le Fort I fracture level, from the lateral rim of the nasal aperture through to the pterygomaxillary
junction bilaterally (figure 4), thereby sectioning the maxilla horizontally.