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Liu J, Zhao J, Wang Y, Zhao Y, Han J, Yang D. Endoscopic endonasal transpterygoid nasopharyngectomy: Anatomical considerations and technical note. Head Neck 2024; 46:306-320. [PMID: 37987238 DOI: 10.1002/hed.27581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/01/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The study was designed to identify new landmarks in the parapharyngeal segment of the internal carotid artery (ICA) for nasopharyngectomy and describe a surgical procedure of endoscopic endonasal transpterygoid nasopharyngectomy (EETPN). METHODS Four cadaveric specimens were injected with colored silicone and subjected to CT scanning before dissection. The nasopharyngeal skull base was exposed using the endoscopic endonasal transpterygoid approach. The clinical data of four patients with nasopharyngeal malignances who underwent EETPN were reviewed. RESULTS The lateral edge of the longus capitis muscle medially; the foramen lacerum, petrous apex spine and the stump of the levator veli palatini muscle superior laterally; and the upper parapharyngeal ICA laterally constitute the ICA-longus capitis muscle-petrous apex spine triangle which was a novel landmark for the upper parapharyngeal segment of the ICA. CONCLUSION The ICA-longus capitis muscle-petrous apex spine triangle are important landmarks of the upper parapharyngeal segment of the ICA.
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Affiliation(s)
- Jianfeng Liu
- Department of Otorhinolaryngology - Head & Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jianhui Zhao
- Department of Otorhinolaryngology - Head & Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yibei Wang
- Department of Otorhinolaryngology - Head & Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yu Zhao
- Department of Otorhinolaryngology - Head & Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jun Han
- Department of Otorhinolaryngology - Head & Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Dazhang Yang
- Department of Otorhinolaryngology - Head & Neck Surgery, China-Japan Friendship Hospital, Beijing, China
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孙 希, 薛 凯, 刘 强, 张 焕, 刘 全, 蒋 晓, 赵 可, 顾 晔, 宋 小, 余 洪. [Endoscopic transoral retropharyngeal lymphadenectomy]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:81-86. [PMID: 35172541 PMCID: PMC10128319 DOI: 10.13201/j.issn.2096-7993.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Indexed: 06/14/2023]
Abstract
Objective:The aim of this study is to explore the anatomy and surgical approach of retropharyngeal lymphadenectomy via endoscopic transoral approach. Methods:The retropharyngeal spaces were studied with three fresh frozen cadaver head (6 sides) in the anatomical laboratory of Eye, Ear, Nose and Throat Hospital of Fudan University through endoscopic transoral approach. The superior pharyngeal constrictor muscle, medial pterygoid muscle, tendon of tensor veli palatini muscle, fat of prestyloid space, ascending palatine artery and its branches, styloglossus, stylopharyngeus, stylohyoideus, external carotid artery, levator veli palatini, carotid sheath, ascending pharyngeal artery and longus capitis muscle were revealed in order. The above-mentioned structures were photographed with a 0° Karl Storz nasal endoscope and adjacent relationships were recorded. A case of metastatic retropharyngeal lymphadenopathy was reviewed and the surgical methods and techniques of retropharyngeal lymphadenectomy via endoscopic transoral approach were introduced in detail. Results:The retropharyngeal space and related anatomical structures were exposed through endoscopic transoral approach in all specimens. The styloglossus, stylopharyngius and levator veli palatini are the markers of locating the internal carotid artery. The superior pharyngeal constrictor muscle, medial pterygoid muscle, styloid muscle group, longus capitis muscle and carotid sheath are the markers that can be used to locate the retropharyngeal lymph nodes. Ascending palatine artery, ascending pharyngeal artery and internal carotid artery are the main arteries involved in retropharyngeal lymphadenectomy via endoscopic transoral approach. Conclusion:Endoscopic transoral approach is a new surgical technique to perform retropharyngeal lymphadenectomy safely and completely.
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Affiliation(s)
- 希才 孙
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 凯 薛
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 强 刘
- 复旦大学附属眼耳鼻喉科医院放射科Department of Radiology, Eye & ENT Hospital, Fudan University
| | - 焕康 张
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 全 刘
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 晓文 蒋
- 华中科技大学协和深圳医院(南山人民医院)耳鼻咽喉科Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital[Nanshan Hospital]
| | - 可庆 赵
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 晔 顾
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 小乐 宋
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 洪猛 余
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- 中国医学科学院内镜下鼻颅底肿瘤外科治疗技术创新单元(2018RU003)Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor[2018RU003], Chinese Academy of Medical Sciences
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