Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

2021 ◽  
Author(s):  
Aldo Eguiluz-Melendez ◽  
Sergio Torres-Bayona ◽  
María Belen Vega ◽  
Vanessa Hernández-Hernández ◽  
Erik W. Wang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Parapharyngeal Space ◽  
Jugular Bulb ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
The Novel ◽  
Main Trunk ◽  
Transcervical Approach ◽  
Semiquantitative Evaluation ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to describe the anatomical nuances, feasibility, limitations, and surgical exposure of the parapharyngeal space (PPS) through a novel minimally invasive keyhole endoscopic-assisted transcervical approach (MIKET). Design Descriptive cadaveric study. Setting Microscopic and endoscopic high-quality images were taken comparing the MIKET approach with a conventional combined transmastoid infralabyrinthine transcervical approach. Participants Five colored latex-injected specimens (10 sides). Main Outcome Measures Qualitative anatomical descriptions in four surgical stages; quantitative and semiquantitative evaluation of relevant landmarks. Results A 5 cm long inverted hockey stick incision was designed to access a corridor posterior to the parotid gland after independent mobilization of nuchal and cervical muscles to expose the retrostyloid PPS. The digastric branch of the facial nerve, which runs 16.5 mm over the anteromedial part of the posterior belly of the digastric muscle before piercing the parotid fascia, was used as a landmark to identify the main trunk of the facial nerve. MIKET corridor was superior to the crossing of the accessory nerve over the internal jugular vein within 17.3 mm from the jugular process. Further exposure of the occipital condyle, vertebral artery, and the jugular bulb was achieved. Conclusion The novel MIKET approach provides in the cadaver straightforward access to the upper and middle retrostyloid PPS through a natural corridor without injuring important neurovascular structures. Our work sets the anatomical nuances and limitations that should guide future clinical studies to prove its efficacy and safety either as a stand-alone procedure or as an adjunct to other approaches, such as the endonasal endoscopic approach.

The nerve to the mylohyoid as a donor for facial nerve reanimation procedures: a cadaveric feasibility study

2007 ◽  
Vol 106 (4) ◽  
pp. 677-679 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
Leslie Acakpo-Satchivi ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skin Incision ◽  
Digastric Muscle ◽  
Facial Muscle ◽  
Muscle Paralysis ◽  
Mean Diameter ◽  
Human Cadavers ◽  
The Mean ◽  
Anterior Belly ◽  
Neurovascular Structures

Object Facial nerve injury with resultant facial muscle paralysis is disfiguring and disabling. Reanimation of the facial nerve has been performed using different regional nerves. The nerve to the mylohyoid has not been previously explored as a donor nerve for facial nerve reanimation procedures. Methods Five fresh adult human cadavers (10 sides) were dissected to identify an additional nerve donor candidate for facial nerve neurotization. Using a curvilinear cervicofacial skin incision, the nerve to the mylohyoid and facial nerve were identified. The nerve to the mylohyoid was transected at its point of entrance into the anterior belly of the digastric muscle. Measurements were made of the length and diameter of the nerve to the mylohyoid, and this nerve was repositioned superiorly to the various temporofacial and cervicofacial parts of the extracranial branches of the facial nerve. All specimens had a nerve to the mylohyoid. The mean length of this nerve available inferior to the mandible was 5.5 cm and the mean diameter was 1 mm. In all specimens, the nerve to the mylohyoid reached the facial nerve stem and the temporofacial and cervicofacial trunks without tension. No gross evidence of injury to surrounding neurovascular structures was identified. Conclusions To the authors' knowledge, the use of the nerve to the mylohyoid for facial nerve reanimation has not been explored previously. Based on the results of this cadaveric study, the use of the nerve to the mylohyoid may be considered for facial nerve reanimation procedures.

scholarly journals Migration of Broken Dental Needle Through the Internal Jugular Vein in the Parapharyngeal Space

2020 ◽  
Author(s):  
Jeffrey C Teixeira ◽  
Lingga Adidharma ◽  
George L Coppit ◽  
Wayne Cardoni
Keyword(s):  
Skull Base ◽  
Internal Jugular Vein ◽  
Time Course ◽  
Parapharyngeal Space ◽  
Jugular Vein ◽  
Jugular Foramen ◽  
High Potential ◽  
Rare Occurrence ◽  
Transcervical Approach ◽  
Neurovascular Structures

ABSTRACT Accidental broken dental needles during dental blocks have become a rare occurrence but still occur. Although the treatment for such occurrence is controversial, an increasing body of literature demonstrates that migration of such needles is possible. In this case, we report on a 48-year-old male with migration of a broken dental needle from an inferior alveolar block. Over the course of 2 years, we demonstrated radiological documentation of the course of migration with penetration of the internal jugular vein at the jugular foramen which was subsequently successfully retrieved through a transcervical approach without neurovascular injury. This case is unique given the location of migration to the skull base as well as radiologically documented time course. Furthermore, it highlights the need for prompt retrieval of broken dental needles given the high potential of migration and injury to neurovascular structures.

scholarly journals Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study

2018 ◽  
Vol 80 (05) ◽  
pp. 518-526
Author(s):  
Jaafar Basma ◽  
L. Madison Michael ◽  
Jeffrey M. Sorenson ◽  
Jon H. Robertson
Keyword(s):  
Surgical Approach ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Surgical Anatomy ◽  
Cervical Region ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
Microsurgical Anatomy ◽  
Anatomical Landmarks ◽  
Transcervical Approach

Abstract Introduction The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Methods Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Results Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. Conclusion The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.

The rectus capitis lateralis and the condylar triangle: important landmarks in posterior and lateral approaches to the jugular foramen

2017 ◽  
Vol 127 (6) ◽  
pp. 1398-1406 ◽  
Author(s):  
Michael A. Cohen ◽  
Alexander I. Evins ◽  
Gennaro Lapadula ◽  
Leopold Arko ◽  
Philip E. Stieg ◽  
...  
Keyword(s):  
Transverse Process ◽  
Jugular Foramen ◽  
Terminal Segment ◽  
Occipital Bone ◽  
Occipital Condyle ◽  
Occipital Artery ◽  
Digastric Muscle ◽  
Far Lateral ◽  
Neurovascular Structures ◽  
Superior Oblique

OBJECTIVEThe rectus capitis lateralis (RCL) is a small posterior cervical muscle that originates from the transverse process of C-1 and inserts onto the jugular process of the occipital bone. The authors describe the RCL and its anatomical relationships, and discuss its utility as a surgical landmark for safe exposure of the jugular foramen in extended or combined skull base approaches. In addition, the condylar triangle is defined as a landmark for localizing the vertebral artery (VA) and occipital condyle.METHODSFour cadaveric heads (8 sides) were used to perform far-lateral, extended far-lateral, combined transmastoid infralabyrinthine transcervical, and combined far-lateral transmastoid infralabyrinthine transcervical approaches to the jugular foramen. On each side, the RCL was dissected, and its musculoskeletal, vascular, and neural relationships were examined.RESULTSThe RCL lies directly posterior to the internal jugular vein—only separated by the carotid sheath and in some cases cranial nerve (CN) XI. The occipital artery travels between the RCL and the posterior belly of the digastric muscle, and the VA passes medially to the RCL as it exits the C-1 foramen transversarium and courses posteriorly toward its dural entrance. CNs IX–XI exit the jugular foramen directly anterior to the RCL. To provide a landmark for identification of the occipital condyle and the extradural VA without exposure of the suboccipital triangle, the authors propose and define a condylar triangle that is formed by the RCL anteriorly, the superior oblique posteriorly, and the occipital bone superiorly.CONCLUSIONSThe RCL is an important surgical landmark that allows for early identification of the critical neurovascular structures when approaching the jugular foramen, especially in the presence of anatomically displacing tumors. The condylar triangle is a novel and useful landmark for identifying the terminal segment of the hypoglossal canal as well as the superior aspect of the VA at its exit from the C-1 foramen transversarium, without performing a far-lateral exposure.

Epithelioid haemangioendothelioma in the parapharyngeal space

2006 ◽  
Vol 120 (6) ◽  
pp. 505-507 ◽  
Author(s):  
J-C Lee ◽  
B-J Lee ◽  
S-G Wang ◽  
H-W Kim
Keyword(s):  
Endothelial Cells ◽  
Facial Nerve ◽  
Head And Neck ◽  
Soft Tissues ◽  
Parapharyngeal Space ◽  
Malignant Potential ◽  
Vascular Neoplasm ◽  
Cytoplasmic Vacuolation ◽  
Upper And Lower Extremities ◽  
Epithelioid Haemangioendothelioma

Epithelioid haemangioendothelioma (EHE) is an uncommon vascular neoplasm which occurs rarely in the head and neck and has an unpredictable clinical behaviour. It is characterized by round or spindle-shaped endothelial cells with cytoplasmic vacuolation. Most often, EHE arises from the soft tissues of the upper and lower extremities, and it has borderline malignant potential. We describe the first reported case of EHE in the parapharyngeal space, which was treated successfully via a transcervical–transparotid approach (following angiography with embolization), without massive intra-operative bleeding or facial nerve damage.

Complications of keratosis obturans

2006 ◽  
Vol 120 (9) ◽  
pp. 740-744 ◽  
Author(s):  
N C Saunders ◽  
R Malhotra ◽  
N Biggs ◽  
P A Fagan
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
External Auditory Canal ◽  
Bone Erosion ◽  
Disease Process ◽  
Jugular Bulb ◽  
Horizontal Semicircular Canal ◽  
The Third ◽  
Tegmen Tympani ◽  
External Auditory Canal Cholesteatoma

Three patients with extensive keratosis obturans were treated during a 12-month period. One presented with an idiopathic sensorineural hearing loss and was found to have keratosis obturans in the contralateral, asymptomatic ear. The disease process had resulted in a horizontal semicircular canal fistula in what was now, effectively, the only hearing ear. The second patient had an extensive dehiscence of the tegmen tympani. The third presented with a facial palsy. An automastoidectomy cavity was present, with circumferential skeletonization of the descending facial nerve over a length of 1.5 cm and dehiscence of the temporomandibular joint and jugular bulb. All three patients were successfully treated by surgical formalization of their automastoidectomy cavities. They appeared to represent cases of keratosis obturans rather than external auditory canal cholesteatoma, on the basis of previously published reports.These complications and patterns of bone erosion have not previously been described in keratosis obturans. The third patient is believed to have the most extensive case of keratosis obturans yet described.

Anterior Facial Nerve Rerouting in Cranial Base Surgery: A Comparison of Three Techniques

1996 ◽  
Vol 115 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Peter G. Von Doersten ◽  
Robert K. Jackler
Keyword(s):  
Facial Nerve ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Cranial Base ◽  
Clinical Impression ◽  
Canal Wall ◽  
Posterior Aspect ◽  
Pivot Point ◽  
Carotid Canal ◽  
Canal Wall Down

Anterior rerouting of the facial nerve is a maneuver designed to enhance exposure of the jugular foramen and carotid canal during resection of cranial base tumors. Our clinical impression is that the degree of additional exposure afforded by moving the facial nerve varies considerably according to both anatomic variations and the technique used. Three possible techniques exist based on the extent of facial nerve mobilization and point of rotation: canal wall up-second genu pivot point (CWU-2G); canal wall down-second genu pivot point (CWD-2G); and canal wall down-first genu pivot point (CWD-1G). We anatomically studied 20 human cadaver heads to establish clinically relevant guidelines for the selective use of these techniques. At the level of the dome of the jugular bulb, the facial nerve mobilized anteriorly a mean of 4.2 mm for CWU-2G, 10 mm for CWD-2G, and 14 mm for CWD-1G. Detailed analysis of numerous measurements and rotation angles suggests that the typical exposure afforded by the various rerouting techniques is as follows: CWU-2G, complete exposure of the jugular bulb; CWD-2G, exposure of the jugular bulb and a mean of 6 mm of the posterior aspect of the carotid artery; and CWD-1G, exposure of the jugular bulb and entire carotid genu. Minimizing the amount of facial nerve manipulation needed to achieve sufficient surgical exposure helps optimize postoperative functional status.

Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome

2019 ◽  
Author(s):  
Felipe Constanzo ◽  
Ricardo Ramina ◽  
Mauricio Coelho Neto
Keyword(s):  
Facial Nerve ◽  
Medical Center ◽  
Demographic Data ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Eagle’S Syndrome ◽  
Transcervical Approach ◽  
Marginal Mandibular Branch ◽  
Mean Size ◽  
Mandibular Branch

Abstract Objectives Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy. Design Preset study is a single-center retrospective cohort study. Setting The research was conducted at a tertiary medical center. Participants From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach. Main Outcome Measures Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed. Results Mean size of the styloid processes was of 3.34 cm on the operated side (2.3–4.7 cm) and 2.98 cm on the other (2–4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series. Conclusions Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.

scholarly journals Component Approach to the Temporomandibular Joint and Coronoid Process

2014 ◽  
Vol 7 (4) ◽  
pp. 323-326 ◽  
Author(s):  
Miles J. Pfaff ◽  
James Clune ◽  
Derek Steinbacher
Keyword(s):  
Facial Nerve ◽  
Temporomandibular Joint ◽  
Coronoid Process ◽  
Aesthetic Outcome ◽  
Limited Access ◽  
Superficial Musculoaponeurotic System ◽  
Ideal Approach ◽  
Component Approach ◽  
Neurovascular Structures ◽  
The Ideal

Reconstruction of the temporomandibular joint (TMJ) region is challenging. The conventional direct preauricular incision permits only limited access to the TMJ and surrounding structures, therefore risking injury to the facial nerve during retraction. The ideal approach allows sufficient exposure, preservation of underlying neurovascular structures, and achieves an optimal aesthetic outcome. We describe a preauricular posttragal incision with a superficial musculoaponeurotic system flap to allow wide exposure of the zygomatic arch, TMJ, condyle, and coronoid process. We postulate that this approach improves access, lessens the amount of retraction required, and creates a more inconspicuous scar.

Sign in / Sign up

Export Citation Format

Share Document