In Reply: Minimally Invasive Exposure of the Maxillary Artery at the Anteromedial Infratemporal Fossa

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)

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Endoscopic Endonasal Approach to the Pterygopalatine Fossa: Anatomic Study

Neurosurgery ◽

10.1227/01.neu.0000044562.73763.00 ◽

2003 ◽

Vol 52 (2) ◽

pp. 374-380 ◽

Cited By ~ 82

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.

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

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v3.n3.13935 ◽

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.

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Minimally invasive transmaxillary endoscopic retrieval of a displaced third maxillary molar into the infratemporal fossa

Pan Arab Journal of Rhinology ◽

10.4103/pajr.pajr_23_20 ◽

2021 ◽

Vol 11 (1) ◽

pp. 67

Author(s):

Kamal Ebeid

Keyword(s):

Minimally Invasive ◽

Infratemporal Fossa ◽

Maxillary Molar ◽

Endoscopic Retrieval

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Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study

Journal of Neurosurgery ◽

10.3171/2019.7.jns191743 ◽

2020 ◽

Vol 133 (6) ◽

pp. 1948-1959 ◽

Cited By ~ 2

Author(s):

Mina M. Gerges ◽

Saniya S. Godil ◽

Iyan Younus ◽

Michael Rezk ◽

Theodore H. Schwartz

Keyword(s):

Carotid Artery ◽

Parapharyngeal Space ◽

Infratemporal Fossa ◽

Middle Meningeal Artery ◽

Endoscopic Approach ◽

Surgical Approaches ◽

Maxillary Artery ◽

Lateral Pterygoid Muscle ◽

Endoscopic Techniques ◽

Endoscopic Transorbital

OBJECTIVEThe infratemporal fossa (ITF) and parapharyngeal space are anatomical regions that can be challenging to access without the use of complex, cosmetically disfiguring approaches. With advances in endoscopic techniques, a new group of surgical approaches to access the intracranial space through the orbit has been recently referred to as transorbital neuroendoscopic surgery (TONES). The objective of this study was to establish a transorbital endoscopic approach utilizing the inferior orbital fissure (IOF) to gain access to the ITF and parapharyngeal space and provide a detailed endoscopic anatomical description of this approach.METHODSFour cadaveric heads (8 sides) were dissected using a TONES approach through the IOF to reach the ITF and parapharyngeal space, providing stepwise dissection with detailed anatomical findings and a description of each step.RESULTSAn inferior eyelid approach was made with subperiosteal periorbital dissection to the IOF. The zygomatic and greater wing of the sphenoid were drilled, forming the boundaries of the IOF. The upper head of the lateral pterygoid muscle in the ITF and parapharyngeal space was removed, and 7 distinct planes were described, each with its own anatomical contents. The second part of the maxillary artery was mainly found in plane 1 between the temporalis laterally and the lateral pterygoid muscle in plane 2. The branches of the mandibular nerve (V3) and middle meningeal artery (MMA) were identified in plane 3. Plane 4 was formed by the fascia of the medial pterygoid muscle (MTM) and the tensor veli palatini muscle. The prestyloid segment, found in plane 5, was composed mainly of fat and lymph nodes. The parapharyngeal carotid artery in the poststyloid segment, found in plane 7, was identified after laterally dissecting the styloid diaphragm, found in plane 6. V3 and the origin of the levator and tensor veli palatini muscles serve as landmarks for identification of the parapharyngeal carotid artery.CONCLUSIONSThe transorbital endoscopic approach provides excellent access to the ITF and parapharyngeal space compared to previously described complex and morbid transfacial or transcranial approaches. Using the IOF is an important and useful landmark that permits a wide exposure.

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S123 – New Approaches to Infratemporal Fossa Foreign Body Removal

Otolaryngology ◽

10.1016/j.otohns.2008.05.296 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P118-P118

Author(s):

Andrew R Scott ◽

Thomas B Dodson ◽

Michael P Platt ◽

Ralph B Metson

Keyword(s):

Minimally Invasive ◽

Head And Neck ◽

Foreign Bodies ◽

Infratemporal Fossa ◽

Tertiary Care ◽

Care Facility ◽

Guidance System ◽

Invasive Technique ◽

Hypodermic Needle ◽

Surgical Removal

Objectives 1) To understand indications for removal of foreign bodies (FB) from the head and neck. 2) To be able to describe the use of new surgical technologies for FB removal from the head and neck region. 3) To understand the clinical applications of a novel, minimally-invasive technique for removal of FB from the infratemporal fossa. Methods A retrospective review of 2 cases of infratemporal fossa foreign bodies, which were referred to a tertiary care facility for management utilizing a novel transoral, endoscopic, image-guided approach. Results Both patients presented with pain and trismus following failed attempts to retrieve foreign bodies–1 broken hypodermic needle and 1 torn cottonoid sponge-through open explorations. Use of endoscopic equipment for visualization and image-guidance system for precise localization enabled both objects to be removed through a transoral approach. Surgical removal resulted in improvement in pain and trismus in both patients who were discharged within 24 hours. Conclusions A new approach is now available for the minimally-invasive retrieval of radio-opaque foreign bodies in the infratemporal fossa, which avoids the need for extensive surgical dissection or an external incision.

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