AIM: To illustrate the middle cranial fossa (MCF) approach to the pterygopalatine fossa (PPF), infratemporal fossa (ITF), and parapharyngeal space (PPS) with temporomandibular joint (TMJ) preservation through step-by-step cadaver dissection and discuss certain critical considerations that are inadequately addressed in the literature.

MATERIAL and METHODS: Six sides of three formalin-fixed, latex-injected specimens were dissected under an operating microscope to illustrate this unique approach. All steps were documented.

RESULTS: The MCF approach with TMJ preservation provides excellent access to the PPF and ITF, and limited exposure of the PPS. Key steps include positioning and craniotomy, lateral loop drilling, MCF removal, PPF dissection, ITF dissection, maxillary artery dissection, and PPS dissection.

CONCLUSION: The MCF is a promising corridor for accessing these complex exocranial skull base areas. Although live surgery may be quite different from cadaver dissection, every surgeon must master the relevant anatomy before entering the operation theatre.