scholarly journals Anatomical Variations and Relationships of the Infratemporal Fossa: Foundation of a Novel Endonasal Approach to the Foramen Ovale

2020 ◽  
Author(s):  
Lifeng Li ◽  
Nyall R. London ◽  
Daniel M. Prevedello ◽  
Ricardo L. Carrau
Keyword(s):  
Infratemporal Fossa ◽  
Anatomical Variations ◽  
Maxillary Artery ◽  
Endonasal Approach ◽  
Foramen Ovale ◽  
Novel Approach ◽  
Pterygoid Plate ◽  
Anterior Trunk ◽  
Pterygoid Muscles ◽  
Pterygoid Plexus

Abstract Objective Access to the infratemporal fossa (ITF) is complicated by its complex neurovascular relationships. In addition, copious bleeding from the pterygoid plexus adds to surgical challenge. This study aims to detail the anatomical relationships among the internal maxillary artery (IMA), pterygoid plexus, V3, and pterygoid muscles in ITF. Furthermore, it introduces a novel approach that displaces the lateral pterygoid plate (LPP) to access the foramen ovale. Design and Main Outcome Measures Six cadaveric specimens (12 sides) were dissected using an endonasal approach to the ITF modified by releasing and displacing the LPP and lateral pterygoid muscle (LPTM) as a unit. Subperiosteal elevation of the superior head of LPTM revealed the foramen ovale. The anatomic relationships among the V3, pterygoid muscles, pterygoid plexus, and IMA were surveyed. Results In 9/12 sides (75%), the proximal IMA ran between the temporalis and the LPTM, whereas in 3/12 sides (25%), the IMA pierced the LPTM. The deep temporal nerve was a consistent landmark to separate the superior and inferior heads of LPTM. An endonasal approach displacing the LPP in combination with a subperiosteal elevation of the superior head of LPTM provided access to the posterior trunk of V3 and foramen ovale while sparing injury of the LPTM and exposing the pterygoid plexus. The anterior trunk of V3 traveled anterolaterally along the greater wing of sphenoid in all specimens. Conclusion Displacement of the LPP and LPTM provided direct exposure of foramen ovale and V3 avoiding dissection of the muscle and pterygoid plexus; thus, this maneuver may prevent intraoperative bleeding and postoperative trismus.

scholarly journals PERFORATION OF INFERIOR ALVEOLAR NERVE BY MAXILLARY ARTERY. Perforation of inferior alveolar nerve by maxillary artery

2016 ◽  
Vol 3 (3) ◽  
pp. 124-129
Author(s):  
Prakash B Billakanti
Keyword(s):  
Infratemporal Fossa ◽  
Maxillofacial Surgery ◽  
Inferior Alveolar Nerve ◽  
Anatomical Variations ◽  
Clinical Implications ◽  
Maxillary Artery ◽  
Foramen Ovale ◽  
Anesthetic Agents ◽  
Male Cadaver ◽  
Anatomical Area

La fosa infratemporal es un área anatómica clínicamente importante para la administración de agentes anestésicos locales en odontología y cirugía maxilofacial. Fueron estudiadas variaciones en la anatomía del nervio alveolar inferior y la arteria maxilar en la disección infratemporal. Durante la disección rutinaria de la cabeza en el cadáver de un varón adulto, fue observada una variación excepcional en el origen del nervio alveolar inferior y su relación con las estructuras circundantes. El nervio alveolar inferior se originaba en el nervio mandibular por dos raíces y la primera parte de la arteria maxilar estaba incorporada entre ambas. El origen embriológico de esta variación y sus implicaciones clínicas es debatido. Dado que la arteria maxilar transcurría entre las dos raíces del nervio alveolar inferior, y el nervio estaba fijado entre el foramen oval y el foramen mandibular, el atrapamiento vásculo-nervioso pudo causar entume-cimiento o dolor de cabeza e interferir con la inyección de anestésicos locales en la fosa infratemporal.  Variaciones anatómicas en esta región deben ser tenidas en cuenta, especialmente en casos de tratamiento fallido de neuralgia del trigémino. Infratemporal fossa is clinically important anatomical area for the delivery of local anesthetic agents in dentistry and maxillofacial surgery. Variations in the anatomy of the inferior alveolar nerve and maxillary artery were studied in infratemporal dissection. During routine dissection of the head in an adult male cadaver an unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originated from the mandibular nerve by two roots and the first part of the maxillary artery was incorporated between them. An embryologic origin of this variation and its clinical implications is discussed. Because the maxillary artery runs between the two roots of the inferior alveolar nerve, and the nerve was fixed between the foramen ovale and mandibular foramen, neurovascular entrapment may cause pain numbness or headache and may interfere with the injection of local anesthetics into the infratemporal fossa. Anatomical variations in this region should be kept in mind, particularly in cases of failed treatment of trigeminal neuralgia.

scholarly journals Maxillary Artery runs medial to the mandibular nerve unilaterally: Case report and Literature Review

2021 ◽  
Vol 9 (2.3) ◽  
pp. 8008-8011
Author(s):  
Yonatan Schwartz ◽  
◽  
Vindhya J. Rao ◽  
Lesly Sanchez Alvarez ◽  
Benjamin Wajsberg ◽  
...  
Keyword(s):  
Case Report ◽  
Infratemporal Fossa ◽  
Anatomical Variations ◽  
Mandibular Nerve ◽  
Maxillary Artery ◽  
Lateral Pterygoid Muscle ◽  
The Face ◽  
Posterior Division ◽  
Risk Of Hemorrhage ◽  
Caucasian Female

Background: The maxillary artery supplies the deep structures of the face and cranium. The maxillary artery and the mandibular nerve form a clinically important relation in the infratemporal fossa. Variations of the maxillary artery may complicate dental, oral, and maxillofacial surgeries in this region. Methods: During routine academic dissection of a 91-year-old Caucasian female cadaver, the pterygoid segment of the left maxillary artery was found medial to the posterior division of the mandibular nerve in the infratemporal fossa. Results: The maxillary artery coursed superior to the point of division of the mandibular nerve and remained undivided. Conclusion: This rare unilateral variation will be of interest to anatomists and clinicians, as an understanding of anatomical variations of the maxillary artery can help decrease the risk of hemorrhage and other surgical complications. KEY WORDS: Maxillary artery, Mandibular nerve, Lateral pterygoid muscle, Infratemporal Fossa.

Transnasal endoscopic management of angiofibroma extending to pterygopalatine and infratemporal fossae

2011 ◽  
Vol 125 (7) ◽  
pp. 701-705 ◽  
Author(s):  
S M El Morsy ◽  
Y W Khafagy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Infratemporal Fossa ◽  
Careful Examination ◽  
Surgical Approaches ◽  
Endoscopic Management ◽  
Maxillary Artery ◽  
Resonance Imaging ◽  
Pterygoid Canal ◽  
Pterygoid Muscles

AbstractIntroduction:Surgical approaches to the pterygopalatine and infratemporal fossae are complex and cause significant morbidity. The commonest benign tumour to extend to the pterygopalatine and infratemporal fossae is angiofibroma.Patients and methods:This prospective study included 15 male patients aged 12–27 years with recurrent, severe epistaxis. After computed tomography and magnetic resonance imaging, a modified Wormald and Robinson's two-surgeon approach was used. Follow up, with endoscopy and magnetic resonance imaging, ranged from two to five years.Results:Twelve patients were cured (endoscopically and radiologically). Three patients suffered recurrence, one each in the lateral sphenoid wall, pterygoid canal and infratemporal fossa. Revision surgery was performed, but one patient suffered another recurrence (lateral sphenoid wall with cavernous sinus infiltration) and was referred for gamma knife surgery.Conclusion:This endoscopic two-surgeon technique is an excellent approach for managing angiofibroma extending to the pterygopalatine and infratemporal fossae. Our modification markedly decreased morbidity by avoiding septum opening and sublabial incision, and by enabling better haemostasis (via maxillary artery control). Recurrence may be minimised by careful examination of the lateral sphenoid wall, pterygoid canal and infratemporal fossa pterygoid muscles.

Endoscopic Endonasal Approach to the Infratemporal Fossa

Skull Base ◽  
2007 ◽  
Vol 17 (S 2) ◽  
Author(s):  
Lee Zimmer ◽  
Aaron Brescia ◽  
Bharat Guthikonda ◽  
Jeffrey Keller ◽  
Philip Theodosopoulos
Keyword(s):  
Infratemporal Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Imaging study of the anatomical variations and the maxillary sinus pathology in patients with missing lateral teeth for the application of dental implants

ORL ro ◽  
2016 ◽  
Vol 1 (1) ◽  
pp. 6-12
Author(s):  
Iulian Damian ◽  
Gheorghe-Ionel Comșa
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Dental Implants ◽  
Preoperative Evaluation ◽  
Anatomical Variations ◽  
Accurate Information ◽  
Maxillary Artery ◽  
Lateral Sinus ◽  
Sinus Wall ◽  
Increased Risk

Preoperative evaluation of maxillary sinus anatomy is very important to avoid surgical complications due to close anatomical relations between the sinus and the posterior maxillary teeth and/or edentulous alveolar ridge. Posterior superior alveolar artery is a branch of the maxillary artery and provides the vascularization of the lateral sinus wall and underlying mucosa. Maxillary artery branches should be taken into consideration during sinus lifting procedures and bone augmentation due to increased risk of bleeding by damaging the artery during the osteotomy. Computed tomography (CT) explores three-dimensional anatomic structures and provides complex and accurate information about them. Cone Beam Computed Tomography (CBCT) offers an accurate view of the teeth and surrounding structures at high resolution, despite low-dose radiation used. In this study, the incidence of anatomical variations and sinus pathology were assessed using CBCT. The aim is to evaluate the presence of sinus pathology (sinus mucosal thickening, oro-antral communications, sinus tumors, cysts, polyps), presence and position of the posterior superior alveolar artery. These issues are important because they are about the limits of the dental implants in the posterior maxillary area. The presence of sinus pathology and anatomical variations may predispose to complications and even failures of implantation therapy.  

scholarly journals A Morphometric Study of the Maxillary Artery and Lingula in Relation to Mandibular Ramus Osteotomies and TMJ Surgery

2010 ◽  
Vol 04 (02) ◽  
pp. 166-170 ◽  
Author(s):  
Huseyin Avni Balcioglu ◽  
Cenk Kilic ◽  
Altan Varol ◽  
Hasan Ozan ◽  
Necdet Kocabiyik ◽  
...  
Keyword(s):  
Infratemporal Fossa ◽  
Postoperative Hemorrhage ◽  
Morphometric Study ◽  
Maxillary Artery ◽  
Mandibular Ramus ◽  
Main Trunk ◽  
Tmj Ankylosis ◽  
Bony Landmarks ◽  
Inferior Border ◽  
Mandibular Notch

Objectives: Mandibular osteotomies and resection of the temporomandibular joint (TMJ) ankylosis are the mostly performed surgical procedures in the infratemporal fossa, which is in close proximity with the main trunk of the maxillary artery (MA). It is imperative to avoid the trunk or branches of the maxillary artery, otherwise, massive intraoperative or postoperative hemorrhage may develop. The goal of the study was to investigate the position of the maxillary artery in the infratemporal fossa and the lingula of the mandible.Methods: Significant landmarks were selected on the mandibles of formalin fixed cadavers, and the distances were measured between the maxillary artery and the bony landmarks with a digital caliper.Results: The average distances between the MA and the articular eminence, the medial cortex of the mandibular ramus, the inferior border of the pterygoid fovea and the mandibular notch were 1.67±0.48 mm, 5.38±2.47 mm, 16.84±1.74 mm, 2.94±0.52 mm, respectively. Course pattern of the MA at the subcondylar level was also mapped. In order to determine the position of the lingula, the average distances between the tip of the lingula and the mandibular notch, the inferior border of the ramus, the anterior margin of the ramus and posterior margin of the ramus were measured and found as 15.4±2.1 mm, 49.5±4.3 mm, 18.1±2.7 mm, 16.6±2.5 mm, respectively. No significant differences were found between the right and left sides, for all parameters.Conclusions: The studied parameters will assist and navigate clinicians to determine the anatomic proximity to the maxillary artery, and, minimize the risk of damaging the vessel. (Eur J Dent 2010;4:166-169)

Endoscopic Endonasal Approach to the Pterygopalatine Fossa: Anatomic Study

Neurosurgery ◽  
2003 ◽  
Vol 52 (2) ◽  
pp. 374-380 ◽  
Author(s):  
Alessandra Alfieri ◽  
Hae-Dong Jho ◽  
Raffaele Schettino ◽  
Manfred Tschabitscher
Keyword(s):  
Minimally Invasive ◽  
Infratemporal Fossa ◽  
Lateral View ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Anatomic Study ◽  
Endoscopic Endonasal ◽  
Arteries And Veins ◽  
Anatomic Region

Abstract OBJECTIVE The pterygopalatine fossa is a relatively small anatomic region. Because of its rich vasculonervous contents and its connections with several intracranial and extracranial compartments, it is of particular surgical interest. Because of its deep localization and despite its small size, however, it can require extensive anatomic approaches, especially for invasive cranial base lesions. We performed a cadaveric study through a minimally invasive endoscopic endonasal approach to the pterygopalatine fossa. METHODS We studied 16 pterygopalatine fossae in eight adult cadaveric heads in which the arteries and veins were injected with latex. For visualization, we used rod-lens endoscopes, 4 mm in diameter and 18 cm in length, with 0-, 30-, 45-, and 70-degree lenses. An endonasal middle meatal transpalatine approach, an endonasal middle meatal transantral approach, and an endonasal inferior turbinectomy transantral approach were used. RESULTS The middle meatal transpalatine approach allows for medial exposure of the pterygopalatine fossa contents, the middle meatal transantral approach allows a lateral view, and the inferior turbinectomy transantral approach allows the widest view and room for surgical maneuvering in the medial and lateral compartments of the pterygopalatine fossa and the infratemporal fossa. CONCLUSION Our anatomic study shows that this approach can be considered a valid minimally invasive option to approach pterygopalatine fossa lesions.

ANATOMICAL VARIATIONS OF FORAMEN OVALE AND CLINICAL SIGNIFICANCE

2021 ◽  
pp. 29-31
Author(s):  
Gyan Prakash Mishra ◽  
Ajay Singh Rajput ◽  
Stuti Tandon
Keyword(s):  
Anterior Margin ◽  
Percutaneous Biopsy ◽  
Diagnostic Procedures ◽  
Anatomical Variations ◽  
Middle Cranial Fossa ◽  
Mandibular Nerve ◽  
Foramen Ovale ◽  
Emissary Vein ◽  
Bony Plate ◽  
Cranial Fossa

INTRODUCTION: The foramen ovale is present in sphenoid bone which transmits the mandibular nerve, accessory meningeal artery, emissary vein and the lesser petrosal nerve. This study was conducted on a total 100 si MATERIALS & METHODS: des in 50 dry adult skulls. The shape of foramen will be determined by a visual examination. Margins of foramen were carefully observed for the abnormal bony outgrowths such as sharp bony projections (spine), small blunt bony projection (tubercle), bony plate and bony bar. We obs RESULTS: erved the variations in shape of foramen ovale. We found oval, almond, round, triangular, slit like and irregular shaped in 62%, 20%, 9%, 4%, 3% and 2% foramina ovale respectively. We also observed abnormal bony outgrowths in the foramen ovale like spines, tubercles, bony plate and bony bar. Abnormal bony bar was dividing the foramen ovale in 2 compartments (Anterior and Posterior). The preci CONCLUSIONS: se knowledge of variations of foramen ovale is of valuable contribution for neurosurgeons to development of new and different techniques to approach the middle cranial fossa. In our study we found , 100% tubercles and 80% spines were arising from anterior margin of foramen ovale. These ndings are important for neurosurgeons to approach middle cranial fossa via foramen ovale for neurosurgical and diagnostic procedures like percutaneous biopsy of cavernous sinus tumours, electroencephalographic analysis, microvascular decompression , percutaneous trigeminal rhizotomy and administration of anaesthesia to the mandibular nerve. Surgeons should avoid to go , close to the anterior margin of foramen ovale as spines and tubercles could interrupt the procedures.

Comparison of Endoscopic Endonasal Approach and Lateral Microsurgical Infratemporal Fossa Approach to the Jugular Foramen: An Anatomical Study

2021 ◽  
Author(s):  
Jianfeng Liu ◽  
Carlos D. Pinheiro-Neto ◽  
Dazhang Yang ◽  
Eric Wang ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Infratemporal Fossa ◽  
Deep Understanding ◽  
Type A ◽  
Jugular Foramen ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Complex Anatomy

Abstract Objective The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. Results The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.

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