Endoscopic-assisted approach to infratemporal fossa lesions—a swift and suave method

Abstract Background The infratemporal fossa (ITF) is a deep anatomical space containing critical neurovascular structures. Its complex anatomy presents significant challenges for surgical access, often necessitating extensive craniofacial or transnasal endoscopic approaches. Therefore, minimally invasive techniques that optimize visualization while minimizing morbidity are essential in the management of ITF lesions. Objective To present an alternative and inventive technique for addressing infratemporal fossa lesions Case presentation We report a case series describing a novel endoscopic-assisted technique for managing infratemporal fossa lesions. The series included two cases of infratemporal fossa abscesses secondary to odontogenic infection and disseminated Klebsiella bacteraemia, and one case of an odontogenic keratocystic lesion. Under general anaesthesia, a unicoronal incision was made approximately 2 cm posterior to the hairline and extended preauricularly to expose the zygomatic arch. Following subgaleal dissection with subsequent supraperiosteal dissection, the infratemporal fossa medial to the zygomatic arch was visualized using a rigid Olympus endoscopic system. Endoscopic debridement and lesion removal were performed under direct visualization in less than one hour, providing excellent access with minimal morbidity and favourable cosmetic outcomes. Conclusion This case series highlights an innovative, safe, and efficient endoscopic-assisted technique for infratemporal fossa surgery. By combining the advantages of open and endoscopic visualization through a unicoronal approach, this method enhances surgical precision, reduces operative morbidity, and improves aesthetic results. To our knowledge, this represents the first reported clinical application of this technique for ITF lesions and may offer a promising alternative to conventional open or transnasal approaches.