Endoscopic Denker's Approach for the Treatment of Extensive Sinonasal Tumors: Our Experience

Objectives: Surgical management of large sinonasal tumors, spreading to the pterygopalatine, and infratemporal fossae have always been a challenge for the ENT surgeon and the multidisciplinary team. Methods: Endoscopic Denker's approach allows complete exposure of the anterior, inferior, and lateral recesses of the maxillary sinus, without necessitating a gingivobuccal or a transseptal incision. Moreover, endoscopic Denker's approach facilitates direct, straight entry to the pterygopalatine and infratemporal fossae. Results: Twenty-two patients with extensive sinonasal pathology underwent resection via an endoscopic Denker's approach at our institution, with the majority of them being diagnosed with JNA and inverted papilloma. Denker's procedure facilitated wide exposure of the surgical field and total tumor resection, without significant perioperative complications and good disease-free results in follow up. Conclusions: Our experience is in accordance with the literature, where this approach seems to be superior to alternative options for accessing the pterygopalatine and infratemporal fossae. We believe that adequate expertise in endoscopic sinonasal surgery is necessary prior to embarking on this technique, but in general, it represents a valuable tool in the surgeon's armamentarium. Level of Evidence: 4 Laryngoscope, 131:1458–1462, 2021.