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Orellana-Donoso M, Romero-Zucchino D, Fuentes-Abarca A, Aravena-Ríos P, Sanchis-Gimeno J, Konschake M, Nova-Baeza P, Valenzuela-Fuenzalida JJ. Infraorbital canal variants and its clinical and surgical implications. A systematic review. Surg Radiol Anat 2024; 46:1027-1046. [PMID: 38684553 DOI: 10.1007/s00276-024-03348-3] [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: 12/18/2023] [Accepted: 03/14/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Recent literature highlights anomalous cranial nerves in the sinonasal region, notably in the sphenoid and maxillary sinuses, linked to anatomical factors. However, data on the suspended infraorbital canal (IOC) variant is scarce in cross-sectional imaging. Anatomical variations in the sphenoid sinuses, including optic, maxillary, and vidian nerves, raise interest among specialists involved in advanced sinonasal procedures. The infraorbital nerve's (ION) course along the orbital floor and its abnormal positioning within the orbital and maxillary sinus region pose risks of iatrogenic complications. A comprehensive radiological assessment is crucial before sinonasal surgeries. Cone-beam computed tomography (CBCT) is preferred for its spatial resolution and reduced radiation exposure. OBJECTIVE The aim of this study was to describe the prevalence of anatomical variants of the infraorbital canal (IOC) and report its association with clinical condition or surgical implication. METHODS We searched Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to June 2023. Two authors independently performed the search, study selection, data extraction, and assessed the methodological quality with assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. RESULTS Preliminary results show that three types are prevalent, type 1: the IOC does not bulge into the maxillary sinus (MS); therefore, the infraorbital foramen through the anterior wall of MS could be used for identification of the ION. Type 2: the IOC divided the orbital floor into medial and lateral aspects. Type 3: the IOC hangs in the MS and the entire orbital floor lying above the IOC. From which the clinical implications where mainly surgical, in type 1 the infraorbital foramen through the anterior wall of MS could be used for identification of the ION, while in type 2, since the lateral orbital floor could not be directly accessed an inferiorly transposition of ION is helpful to expose the lateral orbital wall directly with a 0 scope; or using angled endoscopes and instruments, however, the authors opinion is that direct exposure potentially facilitates the visualization and management in complex situations such as residual or recurrent mass, foreign body, and fracture located at the lateral aspect of the canal. Lastly, in type 3, the ION it's easily exposed with a 0° scope. CONCLUSIONS This systematic review identified four IOC variants: Type 1, within or below the MS roof; Type 2, partially protruding into the sinus; Type 3, fully protruding into the sinus or suspended from the roof; and Type 4, in the orbital floor. Clinical recommendations aim to prevent nerve injuries and enhance preoperative assessments. However, the lack of consistent statistical methods limits robust associations between IOC variants and clinical outcomes. Data heterogeneity and the absence of standardized reporting impede meta-analysis. Future research should prioritize detailed reporting, objective measurements, and statistical approaches for a comprehensive understanding of IOC variants and their clinical implications. Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/UGYFZ .
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Affiliation(s)
| | | | | | | | - Juan Sanchis-Gimeno
- Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | - Juan José Valenzuela-Fuenzalida
- Department of Morphology and Function, Faculty of Health Sciences, Universidad de las Américas, Santiago, Chile.
- Departamento de Ciencias Química y Biológicas Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago, Chile.
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Tong JY, Sung J, Chan W, Valentine R, Psaltis AJ, Selva D. Transorbital Endoscopic Approach to the Foramen Rotundum for Infraorbital Nerve Stripping. Ophthalmic Plast Reconstr Surg 2024; 40:321-325. [PMID: 38215465 DOI: 10.1097/iop.0000000000002575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE To develop and evaluate a transorbital endoscopic approach to the foramen rotundum to excise the maxillary nerve and infraorbital nerve branch. METHODS Cadaveric dissection study of 10 cadaver heads (20 orbits). This technique is predicated upon 1) an inferior orbital fissure release to facilitate access to the orbital apex and 2) the removal of the posterior maxillary wall to enter the pterygopalatine fossa (PPF). Angulations along the infraorbital nerve were quantified as follows: the first angulation was measured between the orbitomaxillary segment within the orbital floor and the pterygopalatine segment suspended within the PPF, while the second angulation was taken between the pterygopalatine segment and maxillary nerve as it exited the foramen rotundum. With refinement of the technique, the minimum amount of posterior maxillary wall removal was quantified in the final 5 cadaver heads (10 orbits). RESULTS The mean distance from the inferior orbital rim to the foramen rotundum was 45.55 ± 3.24 mm. The first angulation of the infraorbital nerve was 133.10 ± 16.28 degrees, and the second angulation was 124.95 ± 18.01 degrees. The minimum posterior maxillary wall removal to reach the PPF was 11.10 ± 2.56 mm (vertical) and 11.10 ± 2.08 mm (horizontal). CONCLUSIONS The transorbital endoscopic approach to an en bloc resection of the infraorbital nerve branch up to its maxillary nerve origin provides a pathway to the PPF. This is relevant for nerve stripping in the context of perineural spread. Other applications include access to the superior portion of the PPF in selective biopsy cases or in concurrent orbital pathology.
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Affiliation(s)
- Jessica Y Tong
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Ophthalmology and Vision Sciences, University of Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jeffrey Sung
- Discipline of Ophthalmology and Vision Sciences, University of Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - WengOnn Chan
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Ophthalmology and Vision Sciences, University of Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rowan Valentine
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Otolaryngology Head and Neck Surgery, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Surgery-Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
| | - Alkis J Psaltis
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Otolaryngology Head and Neck Surgery, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Surgery-Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Ophthalmology and Vision Sciences, University of Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Gerlach R, Modesti CL, Rampinelli V. Interdisciplinary Management of Skull Base Tumors. Laryngorhinootologie 2024; 103:S28-S42. [PMID: 38697142 DOI: 10.1055/a-2196-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education. METHOD A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions. RESULTS Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications. CONCLUSION Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.
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Affiliation(s)
| | - Claudia Lodovica Modesti
- Unit of Otolaryngology and Head and Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otolaryngology and Head and Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy
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Zhu C, Li F, Tang X, Cai L, Yin B, Zhang X, Jiang C, Han X. Buccal Fat Pad Augmentation for Midfacial Rejuvenation: Modified Fat Grafting Technique and Ogee Line Remodeling. Aesthet Surg J 2024; 44:117-130. [PMID: 37418635 DOI: 10.1093/asj/sjad214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The volume and position of the buccal fat pad (BFP) change with age, which manifests as a hollow midface. Previous studies showed that autologous fat grafting for BFP augmentation could effectively ameliorate midfacial hollowing. OBJECTIVES The aim of this study was to introduce a modified fat grafting technique for female patients with midfacial hollowing to restore the volume of BFP, and to evaluate the safety and effectiveness of this approach. METHODS Two cadavers were used for the dissection of the BFP and to demonstrate the surgical procedures. Forty-eight patients were treated for midfacial hollowing with the modified grafting strategy. The BFP was filled through a percutaneous zygomatic incision and an immediate amelioration in the hollow area was observed. Improvements were evaluated from measurements of the ogee line and ogee angle, FACE-Q questionnaires, and 3-party satisfaction ratings. Clinical profiles were reviewed and statistically analysed. RESULTS The mean [standard deviation] ogee angle was 6.6° [1.9°] preoperatively and 3.9° [1.4°] postoperatively (average reduction, 2.7°). Patients' ogee lines were smoother postoperatively, with marked improvements in overall appearance, psychological well-being, and social confidence. Patients reported high satisfaction with decision-making and postoperative outcomes and felt 6.61 [2.21] years younger. Overall, 88%, 76%, and 83% of the cases were graded as good or excellent in improvement by surgeon, patient, and the third party, respectively. CONCLUSIONS For age-dependent midfacial hollowing in female patients, the modified percutaneous grafting technique described here was safe and efficacious in restoring BFP volume. This technique produced a smoother ogee line and a natural, younger midfacial contour. LEVEL OF EVIDENCE: 4
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Localisation of the petrous internal carotid artery relative to the vidian canal on computed tomography: a case-control study evaluating the impact of petroclival chondrosarcoma. Acta Neurochir (Wien) 2022; 164:1939-1948. [PMID: 35612666 PMCID: PMC9233644 DOI: 10.1007/s00701-022-05254-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
Background The vidian canal (VC) is normally a reliable anatomical landmark for locating the petrous internal carotid artery (pICA). This study determined the influence of petroclival chondrosarcoma on the relationship between the VC and pICA. Methods Nine patients (3 males, 6 females; median age 49) with petroclival chondrosarcoma, and depiction of the pICA on contrast-enhanced CT, were retrospectively studied. CT-based measurements were performed by two observers, both in the presence of the petroclival chondrosarcoma (case) and on the contralateral control side. The antero-posterior (AP) and craniocaudal (CC) measurements from the posterior VC to the pICA, whether the pICA was in the trajectory of the VC, and the coronal relationship of the pICA anterior genu with the VC were recorded. Results Chondrosarcoma usually displaced the pICA anteriorly (8/9 cases) and superiorly (6/9 cases) relative to the normal side with mean AP and CC measurements of 3.9 mm v 7.2 mm (p = 0.054) and 4.4 mm v 1.4 mm (p = 0.061). The VC trajectory less frequently intersected the pICA cross-section in the presence of chondrosarcoma however it was in the line of the eroded dorsal VC in one case. The anterior genu of the pICA was displaced more laterally by chondrosarcoma but usually remained superior to the VC. Conclusion Petroclival chondrosarcoma variably influences the anatomical relationship between the VC and the pICA, hence requiring an individualised approach. The pICA is usually anterosuperiorly displaced, and the anterior genu remains superior to the VC, however it may be located in the line of the canal.
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Tel A, Bagatto D, Costa F, Sembronio S, Robiony M. Anatomical Computerized Exploration to Excise Malignancies in Deep Facial Compartments: An Advanced Virtual Reality Protocol for a Tailored Surgical Approach. Front Oncol 2022; 12:875990. [PMID: 35646710 PMCID: PMC9137398 DOI: 10.3389/fonc.2022.875990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objective/Hypothesis This study describes the design and application of a novel advanced protocol for virtual three-dimensional anatomical reconstruction of the deep facial compartments, aiming to improve the preoperative understanding and the intraoperative assistance in complex resective surgeries performed for malignant diseases which extend in complex spaces, including the pterygomaxillopalatine fossa, the masticator space, and the infratemporal fossa. Methods This study is a non-profit, retrospective, and single-institution case series. The authors clearly describe in detail imaging acquisition protocols which are suitable to segment each target, and a multilayer reconstruction technique is presented to simulate anatomical structures, with particular focus on vascular networks. Virtual surgical planning techniques are individually designed for each case to provide the most effective access to the deep facial compartments. Intraoperative guidance systems, including navigation and virtual endoscopy, are presented, and their role is analyzed. Results The study included seven patients with malignant disease located in the deep facial compartments requiring radical resection, and all patients underwent successful application of the protocol. All lesions, except one, were subject to macroscopically radical resection. Vascular structures were identified with overall reconstruction rates superior to 90% for major caliber vessels. Prominent landmarks for virtual endoscopy were identified for each case. Conclusions Virtual surgical planning and multilayer anatomical reconstruction are valuable methods to implement for surgeries in deep facial compartments, providing the surgeon with improved understanding of the preoperative condition and intraoperative guidance in critical phases for both open and endoscopic phases. Such techniques allow to tailor each surgical access, limiting morbidity to strictly necessary approaches to reach the disease target.
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Affiliation(s)
- Alessandro Tel
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Daniele Bagatto
- Department of Neuroradiology, University Hospital of Udine, Udine, Italy
| | - Fabio Costa
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Salvatore Sembronio
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Maxillofacial Surgery, University Hospital of Udine, Udine, Italy
- *Correspondence: Massimo Robiony,
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Suntiruamjairucksa J, Chentanez V. Localization of infraorbital foramen and accessory infraorbital foramen with reference to facial bony landmarks: predictive method and its accuracy. Anat Cell Biol 2022; 55:55-62. [PMID: 35131950 PMCID: PMC8968235 DOI: 10.5115/acb.21.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Vilai Chentanez
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Yom KH, Simmons BA, Hock LE, Syed NA, Carter KD, Thurtell MJ, Shriver EM. A direct transcutaneous approach to infraorbital nerve biopsy. Orbit 2021; 41:130-137. [PMID: 33951986 DOI: 10.1080/01676830.2021.1920041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To describe a novel transcutaneous infraorbital nerve biopsy technique which can be performed to aid in the diagnosis of perineural invasion (PNI) of facial cutaneous squamous cell carcinoma (SCC).Methods: A single-center retrospective chart review was performed. Patients diagnosed with SCC with PNI via an infraorbital nerve biopsy between February 2019 and February 2020 were included. Data collected consisted of patient demographics, medical history, clinical presentation and exam, histologic and radiographic findings, treatment, and outcomes.Results: Four patients (3 male, 1 female) met inclusion criteria. The mean age at diagnosis was 79.5 years (range 66-85 years). Three of the four patients had a history of facial skin lesions, including actinic keratosis and SCC, involving the nose, cheek, or ear. One patient had no history of cutaneous malignancy. All patients presented with cranial neuropathies, including total V2 hypoesthesia. The most common presenting symptom was facial pain, followed by diplopia, unilateral facial weakness, and hypoesthesia in the V1 and/or V2 distribution. Transcutaneous infraorbital nerve biopsy in all patients revealed squamous cell carcinoma with no biopsy complications.Conclusion: Definitive diagnosis of PNI can be challenging but is important to minimize tumor-related morbidity. Infraorbital nerve biopsy can establish this diagnosis, especially in the context of negative or indeterminate imaging findings. This work comprises the first description of a transcutaneous approach to infraorbital nerve biopsy, which is a minimally invasive technique that can be performed in an outpatient procedure suite with limited to no sedation.
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Affiliation(s)
- Kelly H Yom
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Brittany A Simmons
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Lauren E Hock
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Nasreen A Syed
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA.,Department of Pathology, University of Iowa, Iowa City, Iowa, USA
| | - Keith D Carter
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Matthew J Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Erin M Shriver
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
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Yan R, Fang X. The endoscopic prelacrimal recess approach to the paramedian middle cranial base: An anatomical study. J Clin Neurosci 2021; 88:251-258. [PMID: 33992193 DOI: 10.1016/j.jocn.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endoscopic endonasal approach to paramedian cranial base implies sacrifice of the nasal structures. OBJECTIVE The present study aimed to illustrate the anatomy and provide critical anatomical landmarks for the endoscopic prelacrimal recess approach (PLRA) to the paramedian middle cranial base. METHODS Anatomical dissections were performed in 10 cadaveric specimens. RESULTS Successful access to the paramedian middle cranial base was achieved in all dissections via the PLRA with the removal of the pterygoid process. For the dissection of the infratemporal fossa and pterygopalatine fossa, the buccal nerve and infraorbital neurovascular bundle can serve as important anatomic landmarks to identify the detailed structures. In the upper parapharyngeal space, the stylopharyngeal aponeurosis can present as anatomical barriers to protect the parapharyngeal segment of the internal carotid artery (PPICA); while the levator veli palatini muscle can be considered as a landmark to locate the PPICA. For the dissection of the Eustachian tube (ET), the isthmus of the ET and ET sulcus can serve as useful landmarks to identify the posterior genu of the ICA and horizontal segment of the petrous ICA respectively. CONCLUSION The PLRA to the paramedian middle cranial base is anatomically feasible and can facilitate preservation of the integrity of nasal structures. The buccal nerve, infraorbital neurovascular bundle, levator veli palatini muscle, stylopharyngeal aponeurosis, the isthmus of the ET, and ET sulcus can serve as critical anatomic landmarks in their respective region and may facilitate the application of this approach.
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Affiliation(s)
- Renchun Yan
- Department of Otorhinolaryngology Head and Neck Surgery, No 2 Zheshan West Road, WuHu, China
| | - Xinyun Fang
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, No 2 Zheshan West Road, WuHu, China.
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Mahmoud MS, Diab AG, Ngombu S, Prevedello DM, Carrau RL. Endoscopic transorbital ligation of the maxillary artery through the inferior orbital fissure. Head Neck 2021; 43:1830-1837. [PMID: 33751697 DOI: 10.1002/hed.26655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Determine the feasibility of accessing the internal maxillary artery (IMA) through a transorbital endoscopic assisted approach through the inferior orbital fissure (IOF). MATERIALS AND METHODS Six adult cadaveric specimens were injected intravascularly with colored latex and dissected on 12 sides. A transorbital endoscopic approach was used to expose the IOF and reach the IMA. RESULTS The average length and width of the anterolateral segment of the IOF were 7.3 and 4 mm, respectively, on the right side and 6.7 and 3.8 mm, respectively, on the left side. Surgical exposure and modification of the IOF allowed the exposure and control of the IMA in all 12 sides. CONCLUSIONS The IOF is a feasible portal to the IMA. The benefits of this approach include vascular control of the distal segment of the maxillary artery. It may provide access in clinical scenarios where endonasal access is not possible (e.g., extensive tumors) or serve as an alternative or complementary surgical route (e.g., control during a total or radical maxillectomy).
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Affiliation(s)
- Mohammad S Mahmoud
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, El-Demerdash Hospital, Ain Shams University, Cairo, Egypt.,Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ahmed G Diab
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA.,Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Stephany Ngombu
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
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Amin JD, Rizzi CJ, Trent G, Greywoode J, Grumbine L, Raghavan P, Vakharia KT. A Consistent, Reliable Landmark to Assist in Placement of Orbital Floor Reconstruction Plates After Blowout Fractures. J Craniofac Surg 2019; 30:2277-2279. [PMID: 31574787 DOI: 10.1097/scs.0000000000005873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To define a reliable and consistent landmark, the superior posterior wall of the maxillary sinus, and to describe how this landmark can be used when repairing orbital floor fractures. METHODS Retrospective chart review. Patients >18 years old diagnosed with unilateral orbital floor and/or zygomaticomaxillary complex fractures. MAIN OUTCOMES The distance from the inferior orbital rim to the superior posterior wall of the maxillary sinus (landmark distance), and the distance from the landmark to the entrance of the optic canal were reported. RESULTS Eighty patients were included in the study. Each had unilateral isolated orbital floor fractures (n = 46) or unilateral zygomaticomaxillary complex fractures with an orbital floor component (n = 34). The contralateral eye in all patients was uninjured, and was used as an internal control. In orbital floor fractures, the mean landmark distance was 38.8 ± 1.4 mm, with a mean distance on the normal side of 38.8 ± 1.6 mm (P = 0.49). Distance to the optic canal on the injured side in isolated orbital floor fracture patients was 9.0 ± 0.8 mm with the same measurement on the normal side being 8.8 ± 0.7 (P = 0.21). In the setting of zygomaticomaxillary complex fracture, the orbital floor length was 38.2 ± 1.3 mm with a mean normal floor length of 37.8 ± 1.1 mm (P = 0.18). The mean distance from the superior posterior wall to optic canal in zygomaticomaxillary complex fractured orbits was 9.2 ± 1.1 mm with a normal side mean length of 9.5 ± 1.0 mm (P = 0.23). No significant difference was found between the measured distances in the fractured orbit and its normal counterpart for both fracture groups. CONCLUSIONS AND RELEVANCE The superior posterior wall of the maxillary sinus is a reliable landmark that can be used to assist in placement of an orbital floor reconstructive plate. The landmark is unchanged despite the presence of an orbital floor or zygomaticomaxillary sinus fracture.
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Affiliation(s)
- Julian D Amin
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Christopher J Rizzi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Graham Trent
- Department of Internal Medicine, University of Lousiville, School of Medicine, Louisville, KY
| | - Jewel Greywoode
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | | | - Prashant Raghavan
- Department of Radiology, University of Maryland, School of Medicine, Baltimore, MD
| | - Kalpesh T Vakharia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland, School of Medicine, Baltimore, MD
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Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach-Long-Term Outcome and Literature Review. J Clin Med 2019; 8:jcm8111873. [PMID: 31694225 PMCID: PMC6912689 DOI: 10.3390/jcm8111873] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity.
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Li L, London NR, Prevedello DM, Carrau RL. Anatomical Variants of the Infraorbital Canal: Implications for the Prelacrimal Approach to the Orbital Floor. Am J Rhinol Allergy 2019; 34:176-182. [PMID: 31610678 DOI: 10.1177/1945892419882127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The infraorbital nerve (ION) and its canal are important landmarks during surgical approaches to the orbital floor and pterygopalatine fossa. However, variations in the anatomy of the infraorbital canal and its corresponding neurovascular bundle may impact the access. Objective To investigate anatomic variants of the infraorbital canal from a prelacrimal endoscopic perspective and to explore the impact of these variants on exposing the lateral orbital floor. Methods Ten cadaveric specimens (20 sides) were dissected through an endonasal prelacrimal approach. Anatomic variants of the ION including location, branching pattern, and relationship to the infraorbital artery were assessed. The need for ION transposition to increase exposure of the lateral orbital floor was also investigated. Results Incidence of previously described Types 1, 2, and 3 ION variants were 30.0%, 60.0%, and 10.0%, respectively. Although the orbital floor could be directly accessed in Type 1 and Type 3 IONs, transposition of the ION was necessary to expose the lateral orbital floor in 5 of 12 sides (42%) for Type 2 ION. Bony dehiscence of the orbital floor was identified in 8 of 20 sides (40%) and branching of the ION in 2 of 20 sides (10%). Conclusion Anatomic variations of the infraorbital canal impact surgical exposure of the orbital floor via a prelacrimal approach. Type 1 and Type 3 ION variants allow a direct exposure of the entire orbital floor. A Type 2 ION may require transposition of the nerve to adequately expose the lateral orbital floor.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Daniel M Prevedello
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio.,Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio.,Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio
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Cârstocea L, Rusu MC, Mateşică DŞ, Săndulescu M. Air spaces neighbouring the infraorbital canal. Morphologie 2019; 104:44-50. [PMID: 31492524 DOI: 10.1016/j.morpho.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The infraorbital canal (IOC) courses through the roof of the maxillary sinus (MS). Different grading systems concerning the topography of the IOC have been proposed. Further, it has been suggested that a transantral IOC would be morphologically related to Haller's cells (HCs). However, we hypothesized that this is not necessarily the case. Hence, we aimed to study the anatomical possibilities of the air spaces located medially to the IOC. MATERIALS AND METHODS The cone-beam computed tomography (CBCT) files of 40 adult patients were retrospectively evaluated. RESULTS The transantral type of IOC was found in 32.5% of patients. The infraorbital recesses of the MS were found medial to the IOC in 20% of patients. As referred to the nasolacrimal canal, these recesses were either prelacrimal (appearing as false isolated air cells) or retrolacrimal (appearing as false HCs). True HCs were found in 10% of patients. They were located medial to the IOC and they drained into the ethmoidal infundibulum (EI), which was distinct from the MS drainage. In 15% of patients, aerated nasolacrimal ducts (NLDs) were found anterior to the EI and medial to the antral angle. They were capable of masquerading either a HC or an infraorbital recess of the MS. CONCLUSION Previous classifications of the IOC, which related it to HCs, were reviewed and the evidence was found to be insufficient to assess the HC-related topography of the IOC. Therefore, to achieve the accurate anatomical identification of the air spaces neighbouring the IOC, the infraorbital recesses of the MS, the HCs, and the aerated NLDs should be carefully discriminated within the antero-supero-medial antral angle.
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Affiliation(s)
- L Cârstocea
- Division of Anatomy, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - M C Rusu
- Division of Anatomy, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - D Ş Mateşică
- Division of Anatomy, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - M Săndulescu
- Division of Implant Prosthetic Therapy, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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Lin BJ, Ju DT, Hsu TH, Chung TT, Liu WH, Hueng DY, Chen YH, Hsia CC, Ma HI, Liu MY, Hung HC, Tang CT. Endoscopic transorbital approach to anterolateral skull base through inferior orbital fissure: a cadaveric study. Acta Neurochir (Wien) 2019; 161:1919-1929. [PMID: 31256277 DOI: 10.1007/s00701-019-03993-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endoscopic transorbital approach (eTOA) has been announced as an alternative minimally invasive surgery to skull base. Owing to the inferior orbital fissure (IOF) connecting the orbit with surrounding pterygopalatine fossa (PPF), infratemporal fossa (ITF), and temporal fossa, the idea of eTOA to anterolateral skull base through IOF is postulated. The aim of this study is to access its practical feasibility. METHODS Anatomical dissections were performed in five human cadaveric heads (10 sides) using 0-degree and 30-degree endoscopes. A stepwise description of eTOA to anterolateral skull base through IOF was documented. The anterosuperior corner of the maxillary sinus in the horizontal plane of the upper edge of zygomatic arch was defined as reference point (RP). The distances between the RP to the foramen rotundum (FR), foramen ovale (FO), and Gasserian ganglion (GG) were measured. The exposed area of anterolateral skull base in the coronal plane of the posterior wall of the maxillary sinus was quantified. RESULTS The surgical procedure consisted of six steps: (1) lateral canthotomy with cantholysis and preseptal lower eyelid approach with periorbita dissection; (2) drilling of the ocular surface of greater sphenoid wing and lateral orbital rim osteotomy; (3) entry into the maxillary sinus and exposure of PPF and ITF; (4) mobilization of infraorbital nerve with drilling of the infratemporal surface of the greater sphenoid wing and pterygoid process; (5) exposure of middle cranial fossa, Meckel's cave, and lateral wall of cavernous sinus; and (6) reconstruction of orbital floor and lateral orbital rim. The distances measured were as follows: RP-FR = 45.0 ± 1.9 mm, RP-FO = 55.7 ± 0.5 mm, and RP-GG = 61.0 ± 1.6 mm. In comparison with the horizontal portion of greater sphenoid wing, the superior and inferior axes of the exposed area were 22.3 ± 2.1 mm and 20.5 ± 1.8 mm, respectively. With reference to the FR, the medial and lateral axes of the exposed area were 11.6 ± 1.1 mm and 15.8 ± 1.6 mm, respectively. CONCLUSIONS The eTOA through IOF can be used as a minimally invasive surgery to access whole anterolateral skull base. It provides a possible resolution to target lesion involving multiple compartments of anterolateral skull base.
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Abhinav K, Panczykowski D, Wang WH, Synderman CH, Gardner PA, Wang EW, Fernandez-Miranda JC. Endoscopic Endonasal Interdural Middle Fossa Approach to the Maxillary Nerve: Anatomic Considerations and Surgical Relevance. Oper Neurosurg (Hagerstown) 2019; 13:522-528. [PMID: 28838109 DOI: 10.1093/ons/opx010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The maxillary nerve (V2) can be approached via the open middle fossa approach. OBJECTIVE To delineate the anatomy of V2 and its specific segments with respect to the endonasal landmarks. We present the endoscopic endonasal interdural middle fossa approach to V2 and its potential application for the treatment of perineural spread in sinonasal/skull base tumors. METHODS Five human head silicon-injected specimens underwent bilateral endoscopic endonasal transpterygoid approaches. V2 prominence and the maxillary strut were identified in the lateral recess along with paraclival carotid protruberance. The regions superior and inferior to V2 corresponding to the anteromedial and anterolateral triangles of the middle fossa were exposed. RESULTS V2 can be classified into 3 segments: interdural (from the Gasserian ganglion to the proximal part of the maxillary strut), intracanalicular (corresponding to the anteroposterior length of the maxillary strut), and pterygopalatine (distal to the maxillary strut and the site of its divisions). Endonasally, the average length of the interdural and the intracanalicular segments were approximately 9 and 4.4 mm, respectively. V2, following its division distal to the maxillary strut, was successfully dissected off the middle fossa dura and transected just distal to the Gasserian ganglion. CONCLUSION Endonasally, the interdural segment can be safely mobilized between the periosteal and meningeal dural layers while ensuring the integrity of the middle fossa dura. This allows transection of infiltrated V2 to facilitate tumor resection without entering the intradural/arachnoidal space. Posteriorly, this is limited by the Gasserian ganglion and superomedially by the dural envelope surrounding the cavernous sinus and the paraclival carotid artery.
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Affiliation(s)
- Kumar Abhinav
- Department of Neurological Surgery, University of Pittsburgh School of Medic-ine, University of Pittsburgh Medical Cent-er, Pittsburgh, Pennsylvania
| | - David Panczykowski
- Department of Neurological Surgery, University of Pittsburgh School of Medic-ine, University of Pittsburgh Medical Cent-er, Pittsburgh, Pennsylvania
| | - Wei-Hsin Wang
- Department of Neurological Surgery, University of Pittsburgh School of Medic-ine, University of Pittsburgh Medical Cent-er, Pittsburgh, Pennsylvania
| | - Carl H Synderman
- Department of Neurological Surgery, University of Pittsburgh School of Medic-ine, University of Pittsburgh Medical Cent-er, Pittsburgh, Pennsylvania.,Departm-ent of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medic-ine, University of Pittsburgh Medical Cent-er, Pittsburgh, Pennsylvania
| | - Eric W Wang
- Department of Neurological Surgery, University of Pittsburgh School of Medic-ine, University of Pittsburgh Medical Cent-er, Pittsburgh, Pennsylvania.,Departm-ent of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medic-ine, University of Pittsburgh Medical Cent-er, Pittsburgh, Pennsylvania
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17
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The pterygopalatine fossa: morphometric CT study with clinical implications. Surg Radiol Anat 2018; 41:161-168. [DOI: 10.1007/s00276-018-2136-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/16/2018] [Indexed: 11/27/2022]
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18
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Abdullah B, Chuen CS, Husain S, Snidvongs K, Wang DY. Is orbital floor a reliable and useful surgical landmark in endoscopic endonasal surgery?: a systematic review. BMC EAR, NOSE, AND THROAT DISORDERS 2018; 18:11. [PMID: 30061792 PMCID: PMC6056923 DOI: 10.1186/s12901-018-0060-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
Background The orbital floor is considered as an important intraoperative reference point in endoscopic sinonasal surgery. The aim of this review is to evaluate its reliability and usefulness as a surgical landmark in endoscopic endonasal surgery. Methods A literature search was performed on electronic databases, namely PUBMED. The following keywords were used either individually or in combination: orbital floor; maxillary sinus roof; endoscopic skull base surgery; endoscopic sinus surgery. Studies that used orbital floor as a landmark for endoscopic endonasal surgery were included in the analysis. In addition, relevant articles were identified from the references of articles that had been retrieved. The search was conducted over a period of 6 months between 1st June 2017 and 16th December 2017. Results One thousand seven hundred forty-three articles were retrieved from the electronic databases. Only 5 articles that met the review criteria were selected. Five studies of the orbital floor (or the maxillary sinus roof) were reviewed, one was a cadaveric study while another 4 were computed tomographic study of the paranasal sinuses. All studies were of level III evidence and consists of a total number of 948 nostrils. All studies showed the orbital floor was below the anterior skull base irrespective of the populations. The orbital floor serves as a guide for safe entry into posterior ethmoids and sphenoid sinus. Conclusions The orbital floor is a reliable and useful surgical landmark in endoscopic endonasal surgery. In revision cases or advanced disease, the normal landmarks can be distorted or absent and the orbital floor serves as a reference point for surgeons to avoid any unintentional injury to the skull base, the internal carotid artery and other critical structures.
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Affiliation(s)
- Baharudin Abdullah
- 1Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kubang Kerian, Kota Bharu, Kelantan Malaysia
| | - Chew Shiun Chuen
- 1Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kubang Kerian, Kota Bharu, Kelantan Malaysia
| | - Salina Husain
- 2Department of Otorhinolaryngology- Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Kornkiat Snidvongs
- 3Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - De Yun Wang
- 4Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228 Singapore
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Tayebi Meybodi A, Little AS, Vigo V, Benet A, Kakaizada S, Lawton MT. The pterygoclival ligament: a novel landmark for localization of the internal carotid artery during the endoscopic endonasal approach. J Neurosurg 2018; 130:1699-1709. [PMID: 29775148 DOI: 10.3171/2017.12.jns172435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The transpterygoid extension of the endoscopic endonasal approach provides exposure of the petrous apex, Meckel's cave, paraclival area, and the infratemporal fossa. Safe and efficient localization of the lacerum segment of the internal carotid artery (ICA) is a crucial part of such exposure. The aim of this study is to introduce a novel landmark for localization of the lacerum ICA. METHODS Ten cadaveric heads were prepared for transnasal endoscopic dissection. The floor of the sphenoid sinus was drilled to expose an extension of the pharyngobasilar fascia between the sphenoid floor and the pterygoid process (the pterygoclival ligament). Several features of the pterygoclival ligament were assessed. In addition, 31 dry skulls were studied to assess features of the bony groove harboring the pterygoclival ligament. RESULTS The pterygoclival ligament was identified bilaterally during drilling of the sphenoid floor in all specimens. The ligament started a few millimeters posterior to the posterior end of the vomer alae and invariably extended posterolaterally and superiorly to blend into the fibrous tissue around the lacerum ICA. The mean length of the ligament was 10.5 ± 1.7 mm. The mean distance between the anterior end of the ligament and midline was 5.2 ± 1.2 mm. The mean distance between the posterior end of the ligament and midline was 12.3 ± 1.4 mm. The bony pterygoclival groove was identified at the confluence of the vomer, pterygoid process of the sphenoid, and basilar part of the occipital bone, running from posterolateral to anteromedial. The mean length of the groove was 7.7 ± 1.8 mm. Its posterolateral end faced the anteromedial aspect of the foramen lacerum medial to the posterior end of the vidian canal. A clinical case illustration is also provided. CONCLUSIONS The pterygoclival ligament is a consistent landmark for localization of the lacerum ICA. It may be used as an adjunct or alternative to the vidian nerve to localize the ICA during endoscopic endonasal surgery.
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Affiliation(s)
- Ali Tayebi Meybodi
- 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Andrew S Little
- 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Vera Vigo
- 2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Arnau Benet
- 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Sofia Kakaizada
- 2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Michael T Lawton
- 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
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20
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Wong RH. Endoscopic Endonasal Transrotundum Middle Fossa Exposure: Technique of Transpterygoid Maxillary Nerve Transposition. World Neurosurg 2018; 112:131-137. [DOI: 10.1016/j.wneu.2018.01.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
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21
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Yağmurlu K, Mooney MA, Almefty KK, Bozkurt B, Tanrıöver N, Little AS, Preul MC. An Alternative Endoscopic Anterolateral Route to Meckel's Cave: An Anatomic Feasibility Study Using a Sublabial Transmaxillary Approach. World Neurosurg 2018; 114:134-141. [PMID: 29510274 DOI: 10.1016/j.wneu.2018.02.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe an endoscopic anterolateral surgical route to the lateral portion of Meckel's cave. METHODS A sublabial transmaxillary transpterygoid approach was performed in 6 cadaveric heads (12 sides). A craniectomy was drilled between the foramen rotundum (FR) and foramen ovale (FO) with defined borders. Extradural dissection was performed up to the V2-V3 junction of the trigeminal ganglion. The working space was analyzed using anatomic measurements. RESULTS The approach allowed for extradural dissection to the lateral aspect of Meckel's cave and provided excellent exposure of V2, V3, and the V2-V3 junction at the gasserian ganglion. The mean distance between the FR and FO along the pterygoid process of the sphenoid bone was 21.3 ± 2.8 mm (range, 18-24.4 mm). The mean distance of V2 and V3 segments from their foramina to the gasserian ganglion junction was 12.0 ± 2.3 mm (range, 9.2-14.6 mm) and 15.2 ± 2.7 mm (range, 12.3-18.5 mm), respectively (6 sides). A potential working area (mean area, 89 mm2) is described. Its superior edge is from the FR to the V2-V3 junction at the gasserian ganglion, its inferior edge is from the FO to the V2-V3 junction at the gasserian ganglion, and its base is from the FO to the FR. The surgical anatomy of the infratemporal fossa, pterygopalatine fossa, and lateral Meckel's cave is highlighted. CONCLUSIONS An endoscopic anterolateral sublabial transmaxillary transpterygoid approach between the FR and FO avoids crossing critical neurovascular structures within the cavernous sinus and pterygopalatine fossa and can provide a safe surgical corridor for laterally based lesions in Meckel's cave.
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Affiliation(s)
- Kaan Yağmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Baran Bozkurt
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Necmettin Tanrıöver
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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22
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Infraorbital foramen localization in orbitozygomatic fractures: a CT study with intraoperative finding. Eur Arch Otorhinolaryngol 2018; 275:809-813. [DOI: 10.1007/s00405-018-4867-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
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23
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Couldwell WT. Letter to the Editor. Infraorbital nerve as a surgical landmark. J Neurosurg 2017; 127:1201. [DOI: 10.3171/2017.4.jns17777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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24
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Ferrareze Nunes C, Beer-Furlan A, Doglietto F, Carrau RL, Prevedello DMS. The McConnell's Capsular Arteries and Their Relevance in Endoscopic Endonasal Approach to the Sellar Region. Oper Neurosurg (Hagerstown) 2017; 14:171-177. [DOI: 10.1093/ons/opx107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/14/2017] [Indexed: 12/26/2022] Open
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Alvernia JE, Hidalgo J, Sindou MP, Washington C, Luzardo G, Perkins E, Nader R, Mertens P. The maxillary artery and its variants: an anatomical study with neurosurgical applications. Acta Neurochir (Wien) 2017; 159:655-664. [PMID: 28191601 DOI: 10.1007/s00701-017-3092-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques. The dimensions, course and branching patterns of the MA were recollected. In addition, 20 three-dimensional reconstruction CT head and neck angiograms (3D CTAs) of actual patients were correlated with the cadaveric findings. RESULTS The MA can be divided in three segments: mandibular, pterygoid and pterygopalatine. Medial and lateral trunk variants regarding its course around the lateral pterygoid muscle can be found. The different branching patterns of the MA have a direct correlation with the course of its main trunk at the base of the skull. Branching and trunk variants on one side do not predict the findings on the contralateral side. CONCLUSION In this study the highly variable course, branching patterns and relations of the MA are illustrated and described in human cadaveric heads and 3D CTAs. MA 3D CTA with bone reconstruction can be useful preoperatively for the identification of the medial or lateral course variants of this artery, particularly its pterygoid segment, which should be taken into account when considering the MA as a donor vessel for an EC-IC bypass.
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Affiliation(s)
- Jorge E Alvernia
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Hidalgo
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marc P Sindou
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | - Chad Washington
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gustavo Luzardo
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eddie Perkins
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Remi Nader
- Texas Center for Neuroscience, Houston, TX, USA
| | - Patrick Mertens
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
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Svider PF, Setzen M, Baredes S, Liu JK, Eloy JA. Overview of Sinonasal and Ventral Skull Base Malignancy Management. Otolaryngol Clin North Am 2017; 50:205-219. [DOI: 10.1016/j.otc.2016.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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