Lateral Congenital Anomalies of the Pharyngeal Apparatus: Part III. Cadaveric Representation of the Course of Second and Third Cleft and Pouch Fistulas

2011 ◽  
Vol 77 (9) ◽  
pp. 1257-1263 ◽  
Author(s):  
Petros Mirilas
Keyword(s):  
Hypoglossal Nerve ◽  
Thyroid Cartilage ◽  
Three Dimensional ◽  
Superior Laryngeal Nerve ◽  
Carotid Bifurcation ◽  
Preoperative Imaging ◽  
Digastric Muscle ◽  
Pharyngeal Apparatus ◽  
Human Cadavers ◽  
Anterior Belly

“Stepladder” surgery for fistula from second or third pharyngeal cleft and pouch is “blind.” Neither intraoperative methylene blue injection and probing nor preoperative imaging (fistulo-gram ultrasound, computed tomography, magnetic resonance imaging) reveal three-dimensional anatomic relations of fistulas. This article describes the most common second and third fistula courses and demonstrates representation of their tracts with wires in human cadavers. A second cleft and pouch fistula, at its external opening, pierces superficial cervical fascia (and platysma), then investing cervical fascia, and travels under the sternocleidomastoid muscle, superficial to the sternohyoid and anterior belly of omohyoid. It ascends along the carotid sheath, and at the upper border of the thyroid cartilage it pierces the pretracheal fascia. Characteristically, it courses between the carotid bifurcation and over the hypoglossal nerve. After passing beneath the posterior belly of the digastric muscle and the stylohyoid, it hooks around both glossopharyngeal nerve and stylopharyngeus muscle. The fistula reaches the pharynx below the superior constrictor muscle. The course of a third cleft and pouch fistula is similar until it has pierced pretracheal fascia; then it passes over the hypoglossal nerve and behind the internal carotid, finally descending parallel to the superior laryngeal nerve, reaching the thyrohyoid membrane cranial to the nerve.

Cervical paragangliomas: diagnosis, management and complications

2001 ◽  
Vol 115 (6) ◽  
pp. 467-474 ◽  
Author(s):  
M. Hossam Thabet ◽  
Hesham Kotob
Keyword(s):  
Carotid Artery ◽  
Superior Laryngeal Nerve ◽  
Carotid Bifurcation ◽  
Styloid Process ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digastric Muscle ◽  
Vascular Injuries ◽  
Nerve Paralysis ◽  
Transcervical Approach

Sixteen patients were diagnosed as suffering from cervical paragangliomas. Eleven patients (68.75 per cent) had twelve carotid paragangliomas (CPs), and five patients (31.25 per cent) had six vagal paragangliomas (VP). One CP (8.33 per cent) originated from paraganglia around the common carotid artery (CCA). Three cases of multiple paragangliomas are presented (18.75 per cent). In 80 per cent (4/5) of VP patients there was widening of the carotid bifurcation similar to that seen with CP. This widening occurred whenever the VP was large enough to grown in between the external carotid artery and internal carotid artery (ECA and ICA). Large VPs may displace the vessels either anterolaterally or anteromedially. Knowledge of the direction of the carotid displacement is essential to avoid intra-operative vascular injuries. Colour flow doppler ultrasound (CFD-US) was found to be a good non-invasive method for diagnosis of vascular neck swellings. It enabled the diagnosis of CP with 100 per cent accuracy, but it was not sufficient for diagnosis of high VP. A transcervical approach, cutting the digastric muscle and the styloid process with the attached ligaments and muscles, was sufficient for excision of most VP. However, midline mandibulotomy might be necessary with high VP. Vascular injuries occurred in 12.5 per cent (2/16) of patients. Superior laryngeal nerve and hypoglossal nerve paralysis occurred, respectively, in (2/11) and (1/11) of patients with CP. Vagal paralysis occurred in all patients with VP. Cerebrovascular accident and post-operative death occurred in one patient (6.26 per cent).

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.

The Anatomical and Clinical Significance of the Superior Laryngeal Nerve

2021 ◽  
pp. 019459982198962
Author(s):  
Kai-ning Lu ◽  
Jin-wang Ding ◽  
Yu Zhang ◽  
Jing-jing Shi ◽  
Li Zhou ◽  
...  
Keyword(s):  
Thyroid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Entry Point ◽  
Horizontal Line ◽  
Lower Edge ◽  
External Branch ◽  
Starting Point ◽  
Human Cadavers ◽  
Medical University

Objective This study summarizes the anatomical features of the superior laryngeal nerve in Chinese to enable the rapid location of the superior laryngeal nerve during an operation. Study Design Retrospective analysis of anatomical data. Setting Hangzhou First People’s Hospital Affiliated to Nanjing Medical University. Methods A total of 71 embalmed human cadavers (132 heminecks) were examined over 3 months. The length and diameter of the internal and external branches of the superior laryngeal nerve and their relationships with different landmarks were recorded. Results The total length of the internal branch of the superior laryngeal nerve was 23.4 ± 6.9 mm. The length of the external branch of the superior laryngeal nerve was 47.7 ± 11.0 mm. Considering the midpoint of the lower edge of the thyroid cartilage as the starting point and using that edge as a horizontal line, when the entry point is above that line, the external branch of the superior laryngeal nerve can be found within 41.1 mm and at an angle of 57.2°. When the entry point is below the lower edge of the thyroid cartilage, the external branch of the superior laryngeal nerve can be found within 34.0 mm and at an angle of 36.5°. Conclusion The superior laryngeal nerve in Chinese people has distinct anatomical characteristics. This article provides a new method of quickly locating the external branch of the superior laryngeal nerve during the operation, which can reduce the probability of damaging the external branch of the superior laryngeal nerve.

scholarly journals A study of variations of anterior belly of digastric muscle

2017 ◽  
Vol 06 (02) ◽  
pp. 101-104
Author(s):  
Pratik Khona ◽  
Deepali U Kulkarni ◽  
Umesh K Kulkarni
Keyword(s):  
Anatomical Variations ◽  
Digastric Muscle ◽  
Second Variation ◽  
Medical Sciences ◽  
Postgraduate Students ◽  
The Third ◽  
Human Cadavers ◽  
Mandibular Region ◽  
Anterior Belly ◽  
Accessory Belly

Abstract Aim : To study the anatomical variations of anterior belly of digastric muscle. Materials & Methods: In the present study, 30 human cadavers from the Department of Anatomy, Belagavi Institute of Medical Sciences, Belagavi were examined for the variations of anterior belly of digastric muscle during routine dissections of undergraduate and postgraduate students. The variations found were neatly dissected and photographs taken wherever necessary. Result: Out of 30 cadavers dissected3 specimens presented with variations. Discussion: First variation found had a unilateral accessory belly of digastric muscle on right side. Second variation was unilateral accessory belly of digastric muscle on left side and the third variation was bilateral accessory slips of digastric muscles. The details of these variations will be dealt in the article. Conclusion: As the variations of anterior belly of digastric muscle are common, the radiologists and the surgeons have to watch out for these while dealing with Sub mandibular region.

Pitfalls in Imaging: Differentiating Intravagal and Carotid Body Paragangliomas

2005 ◽  
Vol 84 (6) ◽  
pp. 348-350 ◽  
Author(s):  
Julie Thorp Kerr ◽  
Vincent D. Eusterman ◽  
Stephen M. Yoest ◽  
Charles A. Andersen
Keyword(s):  
Carotid Body ◽  
Carotid Arteries ◽  
Three Dimensional ◽  
Carotid Bifurcation ◽  
Preoperative Imaging ◽  
External Carotid ◽  
Imaging Features ◽  
Gadolinium Contrast ◽  
Surgical Preparation ◽  
Variable Presentation

We report a case of an intravagal paraganglioma and a case of a carotid body tumor to illustrate a variable presentation of the former in which it mimicked the latter on preoperative imaging. The atypical imaging features of the intravagal paraganglioma included inferior extension to the level of the carotid bifurcation and splaying of the internal and external carotid arteries, features that are similar to those seen in a case of carotid body paraganglioma. Proper differentiation of these lesions permits more appropriate preoperative counseling and surgical preparation. When using magnetic resonance angiography rather than catheter angiography, we advocate the inclusion of gadolinium contrast and three-dimensional time-of-flight techniques to better demonstrate the position of the tumor relative to the carotid bifurcation.

scholarly journals Organ motion in linac-based SBRT for glottic cancer

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Annarita Perillo ◽  
Valeria Landoni ◽  
Alessia Farneti ◽  
Giuseppe Sanguineti
Keyword(s):  
Early Stage ◽  
Displacement Vector ◽  
Thyroid Cartilage ◽  
Three Dimensional ◽  
Target Volume ◽  
Glottic Cancer ◽  
Organ Motion ◽  
Delivery Times ◽  
Significant Difference ◽  
Pre Treatment

Abstract Purpose The purpose of this study is to evaluate inter- and intra-fraction organ motion as well as to quantify clinical target volume (CTV) to planning target volume (PTV) margins to be adopted in the stereotactic treatment of early stage glottic cancer. Methods and materials Stereotactic body radiotherapy (SBRT) to 36 Gy in 3 fractions was administered to 23 patients with early glottic cancer T1N0M0. Patients were irradiated with a volumetric intensity modulated arc technique delivered with 6 MV FFF energy. Each patient underwent a pre-treatment cone beam computed tomography (CBCT) to correct the setup based on the thyroid cartilage position. Imaging was repeated if displacement exceeded 2 mm in any direction. CBCT imaging was also performed after each treatment arc as well as at the end of the delivery. Swallowing was allowed only during the beam-off time between arcs. CBCT images were reviewed to evaluate inter- and intra-fraction organ motion. The relationships between selected treatment characteristics, both beam-on and delivery times as well as organ motion were investigated. Results For the population systematic (Ʃ) and random (σ) inter-fraction errors were 0.9, 1.3 and 0.6 mm and 1.1, 1.3 and 0.7 mm in the left-right (X), cranio-caudal (Y) and antero-posterior (Z) directions, respectively. From the analysis of CBCT images acquired after treatment, systematic (Ʃ) and random (σ) intra-fraction errors resulted 0.7, 1.6 and 0.7 mm and 1.0, 1.5 and 0.6 mm in the X, Y and Z directions, respectively. Margins calculated from the intra-fraction errors were 2.4, 5.1 and 2.2 mm in the X, Y and Z directions respectively. A statistically significant difference was found for the displacement in the Z direction between patients irradiated with > 2 arcs versus ≤ 2 arcs, (MW test, p = 0.038). When analyzing mean data from CBCT images for the whole treatment, a significant correlation was found between the time of delivery and the three dimensional displacement vector (r = 0.489, p = 0.055), the displacement in the Y direction (r = 0.553, p = 0.026) and the subsequent margins to be adopted (r = 0.626, p = 0.009). Finally, displacements and the subsequent margins to be adopted in Y direction were significantly greater for treatments with more than 2 arcs (MW test p = 0.037 and p = 0.019, respectively). Conclusions In the setting of controlled swallowing during treatment delivery, intra-fraction motion still needs to be taken into account when planning with estimated CTV to PTV margins of 3, 5 and 3 mm in the X, Y and Z directions, respectively. Selected treatments may require additional margins.

An Anatomic Study of the External Laryngeal Framework with Surgical Implications

1992 ◽  
Vol 106 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Lawrence Z. Meiteles ◽  
Pi-Tang Lin ◽  
Eugene J. Wenk
Keyword(s):  
Vocal Fold ◽  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Oblique Line ◽  
Type I ◽  
Anatomic Study ◽  
True Vocal Cord ◽  
Precise Knowledge ◽  
Human Cadavers ◽  
Superior Border

Precise knowledge of the level of the vocal fold as projected on the external thyroid cartilage is of critical importance for the performance of thyroplasty type I and supraglottic laryngectomy. Measurements of the external laryngeal framework were made on the larynges of 18 human cadavers in order to identify landmarks that will aid the surgeon in determining endolaryngeal anatomy. On the basis of our results, the following guidelines are recommended: (1) Thyroid cartilage incision for supra-glottic laryngectomy should be made on a line joining the juncture of the upper one third and lower two thirds of the midline length and the juncture of the upper one third and lower two thirds of the oblique line. This will ensure a position above the level of the anterior commissure and the true vocal cord; (2) In thyroplasty type I, the superior border of the thyroid cartilage window should be made at a line joining the midpoint of the midline length and the juncture of the upper two thirds and lower one third of the oblique line. Formation of the cartilage window according to this guideline will ensure its placement lateral to the vocalis muscle.

Bilateral Choanal Atresia Associated with Malformation of the Anterior Skull Base: Embryogenesis and Clinical Implications

1992 ◽  
Vol 101 (11) ◽  
pp. 916-919 ◽  
Author(s):  
Michael E. Dunham ◽  
Robert P. Miller
Keyword(s):  
Skull Base ◽  
Choanal Atresia ◽  
Three Dimensional ◽  
Anterior Skull Base ◽  
Preoperative Imaging ◽  
Clinical Implications ◽  
High Resolution Computed Tomography ◽  
Ethmoid Bone ◽  
Intracranial Complications ◽  
Skull Base Defect

A number of craniofacial and systemic malformations have been described in association with choanal atresia. We report a case of bilateral choanal atresia associated with congenital absence of the cribriform plate, crista galli, and perpendicular plate of the ethmoid bone. The anterior skull base defect was detected by using high-resolution computed tomography with three-dimensional reconstructions. The findings support the mesodermal flow theory of choanal atresia, in which there is excess migration of neural crest cells into the developing nasal septum and posterior choanae. This occurs at the expense of cells that would otherwise form the rest of the ethmoid complex. Clinical implications include the need for adequate preoperative imaging of the anterior skull base and consideration of potential intracranial complications during surgical repair.

scholarly journals Anatomical landmarks of the external branch of the superior laryngeal nerve

2019 ◽  
Vol 12 (4) ◽  
pp. 161-177
Author(s):  
Viktor Y. Malyuga ◽  
Aleksandr A. Kuprin
Keyword(s):  
Thyroid Cartilage ◽  
Oblique Line ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Constrictor Muscle ◽  
External Branch ◽  
Close Proximity ◽  
Inferior Pharyngeal Constrictor ◽  
Line Type

Background. The external branch of the superior laryngeal nerve innervates a cricothyroid muscle, which provides tension in vocal cords and formation of high-frequency sounds. When the nerve is damaged during surgery, patients may notice hoarseness, inability to utter high pitched sounds, “rapid fatigue” of the voice, and dysphagia. According to literature, paresis of an external branch of the superior laryngeal nerve reaches up to 58% after thyroid surgery. Aim: to identify permanent landmarks and topographic variations of the external branch of the superior laryngeal nerve. Materials and methods. The study is based on the autopsy material (21 complexes organs of the neck) and on identification of variations of 40 external branches of the superior laryngeal nerve. We identified two permanent landmarks that are located at the minimum distance from nerve and we made metrical calculations relative to them: oblique line of thyroid cartilage and tendinous arch of the inferior pharyngeal constrictor muscle. Results. The piercing point of the nerve is always located at the inferior pharyngeal constrictor muscle without protruding beyond the oblique line of thyroid cartilage superiorly and tendinous arch of the inferior pharyngeal constrictor muscle anteriorly. The nerve had the parallel direction in 92.8% of cases (angel less than 30 degrees) relative to the oblique line and in 85.7% cases it was in close proximity to this line (at distance up to 4 mm). The proposed topographic classification of the location of the external branch of the superior laryngeal nerve is based on localization of the piercing point of the nerve relative to the length of the oblique line of thyroid cartilage and the risk of nerve damage. In 14.2% of cases, the piercing point was in the front third of the line (type I), and in 50% it was in the middle third of this line (type II). These variations of the external branch of the superior laryngeal nerve was in close proximity to the upper pole of the thyroid gland, which could have lead to its damage during surgery. In type III and IV (35.8%) – the piercing point in the muscle was located as far as possible from the upper pole of the thyroid gland and the greater part of the nerve was covered with the fibers of inferior pharyngeal constrictor muscle. Conclusion. We identified the main orienteers for the search and proposed anatomical classification of the location of the external branch on the superior laryngeal nerve.

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