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Donofrio CA, Cardona JJ, Riccio L, Chaiyamoon A, Shekhawat D, Iwanaga J, Dumont AS, Jackson N, Badaloni F, Tubbs RS, Fioravanti A. The Posterior Auricularis Muscle as Superficial Landmark for the Sigmoid Sinus and Transverse-Sigmoid Sinus Junction: An Anatomical Study. World Neurosurg 2024; 186:e721-e726. [PMID: 38616028 DOI: 10.1016/j.wneu.2024.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Neuronavigation systems coupled with previously reported external anatomical landmarks assist neurosurgeons during intracranial procedures. We aimed to verify whether the posterior auricularis muscle (PAM) could be used as an external landmark for identifying the sigmoid sinus (SS) and the transverse-sigmoid sinus junction (TSSJ) during posterior cranial fossa surgery. METHODS The PAM was dissected in 10 adult cadaveric heads and after drilling the underlying bone, the relationships with the underlying SS and TSSJ were noted. The width and length of the PAM, and the distance between the muscle and reference points (asterion, mastoid tip, and midline), were measured. RESULTS The PAM was identified in 18 sides (9 left, 9 right). The first 20 mm of the muscle length (mean 28.28 mm) consistently overlay the mastoid process anteriorly and the proximal half of the SS slightly posteriorly on all sides. The superior border was a mean of 2.22 mm inferior to the TSSJ and, especially when the muscle length exceeded 20 mm, this border extended closer to the transverse sinus; it was usually found at a mean of 3.11 mm (range 0.0-13.80 mm) inferior to the distal third of the transverse sinus. CONCLUSIONS Superficial landmarks give surgeons improved surgical access, avoiding overexposure of deep neurovascular structures and reducing brain retraction. On the basis of our cadaveric study, the PAM is a reliable and accurate direct landmark for identifying the SS and TSSJ. The PAM could potentially be used for guiding the retrosigmoid approach.
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Affiliation(s)
- Carmine Antonio Donofrio
- Department of Neurosurgery, ASST Cremona, Cremona, Italy; Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy.
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lucia Riccio
- Department of Neurosurgery, ASST Cremona, Cremona, Italy
| | - Arada Chaiyamoon
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomy, Faculty of Medicine, Khon Kaen, Thailand
| | - Devendra Shekhawat
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Neal Jackson
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Filippo Badaloni
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Isaacson G, Wulc AE. Applicability of a sheep model for training in plastic surgery of eyelids and orbit. EAR, NOSE & THROAT JOURNAL 2021; 101:43S-49S. [PMID: 34551606 DOI: 10.1177/01455613211047036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To test the applicability of a fresh tissue model for teaching facial plastic techniques and approaches to the eyelids and orbit. DESIGN Observational animal experiments. SUBJECTS Ten prepubescent sheep heads harvested following humane euthanasia at the completion of unrelated live animal research. METHODS Young sheep were saline perfused at the end of an in vivo protocol. Head and neck tissues were harvested and refrigerated for 3-7 days. An experienced oculoplastic surgeon and an otolaryngologist explored the feasibility of common oculoplastic procedures in the ovine model. RESULTS The model has potential for teaching basic principles in eyelid surgery including upper lid blepharoplasty, aponeurotic ptosis repair, upper lid gold weight lid loading for facial paralysis, lateral canthotomy and inferior limb cantholysis, lower lid tightening, and transconjunctival approach to the orbital floor. Eye muscle advancement, optic nerve sheath fenestration, and enucleation also accurately simulated human surgery. Anatomic variations limit the sheep model for orbital floor reconstruction and lacrimal drainage procedures. CONCLUSIONS The sheep head and neck provide an inexpensive, safe model for developing skills in several oculoplastic procedures. Formal simulation testing is needed to confirm these expert opinions.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head and Neck Surgery, 12314Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.,Departments of Pediatrics, 12314Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Allan E Wulc
- Department of Ophthalmology, 12312Drexel University College of Medicine, Philadelphia, PA, USA.,Department of Ophthalmology, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Wang D, Chen B. Comment on: "Efficacy and Safety of Lyophilized Articular Cartilage Matrix as an Injectable Facial Filler". Aesthetic Plast Surg 2021; 45:1957-1958. [PMID: 33660015 DOI: 10.1007/s00266-021-02194-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Danying Wang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing, 100144, China
| | - Bo Chen
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing, 100144, China.
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