Locating and Preserving the Sphenopalatine Ganglion in Endoscopic Endonasal Pterygopalatine Fossa Surgery: An Anatomical Study

2019 ◽  
Vol 34 (3) ◽  
pp. 348-351
Author(s):  
Daniel B. Spielman ◽  
Matthew Kim ◽  
Jonathan Overdevest ◽  
David A. Gudis
Keyword(s):  
Trigeminal Nerve ◽  
Anatomical Study ◽  
Surgical Anatomy ◽  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
Sphenopalatine Ganglion ◽  
Nerve Branch ◽  
Endoscopic Endonasal ◽  
Sphenopalatine Foramen ◽  
Dissection Technique

Background The pterygopalatine fossa (PPF) contains numerous important neurovascular structures; notably, the sphenopalatine ganglion (SPG), the maxillary branch of the trigeminal nerve (V2), and the internal maxillary artery. With the advent of extended endoscopic endonasal surgery, the surgical anatomy of the PPF warrants increased investigation. Intraoperative dissection and preservation of the SPG is essential to prevent postoperative xeropthalmia and facial hypoesthesia. Objective This study aims to (1) describe a novel dissection technique for identifying the SPG and (2) define the SPG location relative to the sphenopalatine foramen (SPF), which is a consistently identifiable landmark. Methods Eight cadaveric PPFs were dissected in step-wise fashion. An endoscopic medial maxillectomy was performed, the SPF was identified, and the posterior maxillary wall was resected. The maxillary branch of the trigeminal nerve (V2) was identified anterolaterally in its infraorbital canal and traced medially to identify the pterygopalatine nerve to the SPG. The lateral distance and superior/inferior distance from the SPG to the fixed SPF was measured. Results The surgical technique described allowed for reliable identification of the SPG. The SPG was located on average 4.5 ± 1.1 mm lateral and 1 ± 1.4 mm inferior to the SPF. Conclusion Identification and preservation of the SPG is necessary to prevent complications in endoscopic endonasal PPF surgery. The SPG can be reliably located near the SPF by following the pterygopalatine nerve branch of V2.

Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations

2005 ◽  
Vol 19 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Luigi M. Cavallo ◽  
Andrea Messina ◽  
Paul Gardner ◽  
Felice Esposito ◽  
Amin B. Kassam ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Study ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Anatomical Dissection ◽  
Clinical Considerations ◽  
Functional Surgery ◽  
Safe Approach

Object The pterygopalatine fossa is an area located deep in the skull base. The microsurgical transmaxillary–transantral route is usually chosen to remove lesions in this region. The increasing use of the endoscope in sinonasal functional surgery has more recently led to the advent of the endoscope for the treatment of tumors located in the pterygopalatine fossa as well. Methods An anatomical dissection of three fresh cadaveric heads (six pterygopalatine fossas) and three dried skull base specimens was performed to evaluate the feasibility of the approach and to illustrate the surgical landmarks that are useful for operations in this complex region. The endoscopic endonasal approach allows a wide exposure of the pterygopalatine fossa. Furthermore, with the same access (that is, through the nostril) it is possible to expose regions contiguous with the pterygopalatine fossa, either to visualize more surgical landmarks or to accomplish a better lesion removal. Conclusions In this anatomical study the endoscopic endonasal approach to the pterygopalatine fossa has been found to be a safe approach for the removal of lesions in this region. The approach could be proposed as an alternative to the standard microsurgical transmaxillary–transantral route.

Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks

2007 ◽  
Vol 106 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Domenico Solari ◽  
Francesco Magro ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Amir Samii ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Study ◽  
Spatial Relations ◽  
Pterygopalatine Fossa ◽  
Direct Access ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Invasive Approach

Object The pterygopalatine fossa is an area that lies deep within the skull base. The recent extensive use of the endoscopic endonasal approach has provided neurosurgeons with a method to reach various areas of the skull base through a less invasive approach than traditional transcranial or transfacial approaches. This study aims to provide neurosurgeons with new data concerning direct endoscopic measurements and precise anatomical topography features of the pterygopalatine fossa. Methods An anatomical dissection of six fixed cadaver heads (12 pterygopalatine fossae) was performed to analyze spatial relationships and distances between the most important neurovascular structures in this region, and to estimate the size of the endoscopic surgical field for operations in this area. The endoscopic endonasal approach offers direct access to the pterygopalatine fossa through its anteromedial walls. Conclusions Using an endoscopic endonasal approach makes it possible to identify all of the anatomical landmarks of the pterygopalatine fossa and almost all of the contiguous skull base areas.

scholarly journals Endoscopic Endonasal Transturbinate Approach to the Pterygopalatine Fossa in the Management of Juvenile Nasopharyngeal Angiofibromas

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Satoru Kodama ◽  
Hideaki Mabuchi ◽  
Masashi Suzuki
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Early Stage ◽  
Posterior Wall ◽  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
En Bloc ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
Nasopharyngeal Angiofibroma

Pterygopalatine fossa (PPF) is a difficult-to-access anatomic area located behind the posterior wall of the maxillary sinus. Juvenile nasopharyngeal angiofibroma (JNA) often affects this area, and the management of feeding artery to the tumor is important in the surgery. Endoscopic endonasal approach to the PPF without endangering all other nasal structures is useful in the management of JNA. We describe a new approach to the PPF, endoscopic transturbinate approach, which is effective in the management of JNA. Submucous inferior turbinoplasty was performed, and sphenopalatine artery, the feeder to the tumor, was identified at the sphenopalatine foramen. The posterior wall of maxillary sinus was removed. Internal maxillary artery was identified in the PPF and was ligated with a hemoclip. The tumor in the PPF was pushed into the nasal cavity. These procedures were all performed via submucous turbinate tunnel. Then, the tumor was successfully removed in en bloc from the nasal cavity by transnasal approach without ethmoidectomy. This approach improves accessibility and visualization in the PPF and potential to reduce intraoperative bleeding due to ligation of the feeder safely without touching the tumor. Endoscopic transturbinate approach is effective in the management of early stage of JNA.

Endoscopic Anatomy of the Pterygopalatine Fossa

2007 ◽  
Vol 21 (5) ◽  
pp. 644-647 ◽  
Author(s):  
Seth J. Isaacs ◽  
Parul Goyal
Keyword(s):  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Sphenopalatine Foramen ◽  
Neoplastic Processes ◽  
Patient Morbidity ◽  
Infraorbital Canal ◽  
Vidian Canal ◽  
Foramen Rotundum ◽  
Neurovascular Structures

Background The pterygopalatine fossa can be involved with a variety of infectious and neoplastic processes. This region can be entered endoscopically, but endoscopic landmarks to localize the neurovascular structures in the pterygopalatine fossa have not yet been reported. Objectives The purpose of this study is to describe the location of the neurovascular structures in the pterygopalatine fossa in relation to consistent intranasal landmarks. Methods Endoscopic dissections of cadaveric heads were performed. The locations of neurovascular structures in the region were defined. Results The sphenopalatine foramen (SPF) served as the primary intranasal landmark to the pterygopalatine fossa (PPF). Mean distances from the SPF were measured with the following results: SPF to sphenopalatine ganglion (SPG), 4 mm medially and 6 mm laterally; SPF to foramen rotundum (FR), 7 mm; and SPF to vidian canal (VC), 2 mm. The internal maxillary artery followed an irregular and inconsistent course, making it difficult to define a reliable landmark for its location in the fossa. Conclusion Entering the PPF inferior to the horizontal plane of the SPF along a vertical line drawn inferiorly from the infraorbital canal will avoid injury to the major neural structures in the fossa. Because of the inconsistent course and location of the internal maxillary artery, this structure may be at risk no matter where the fossa is entered. These landmarks will allow the surgeon to enter the PPF with more accuracy and less patient morbidity.

A Variation of the Infraorbital Nerve

2010 ◽  
Vol 67 (3) ◽  
pp. onsE315-onsE315 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
William R. May ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Trigeminal Nerve ◽  
Clinical Presentation ◽  
Practical Importance ◽  
Pterygopalatine Fossa ◽  
Infraorbital Nerve ◽  
Nerve Branch ◽  
Male Specimen ◽  
Maxillary Nerve ◽  
Pterygoid Plate ◽  
The Face

Abstract OBJECTIVE: We report the case of a seemingly rare variation of a branch of the trigeminal nerve. This unusual finding is of practical importance to the neurosurgeon because ablation of this nerve(s) in such a case would require modification of technique. The existence of a bifurcated infraorbital nerve is also relevant for application of local anesthesia to portions of the face innervated by the maxillary nerve. CLINICAL PRESENTATION: During cadaveric dissection of the face of a male specimen, 2 branches of the infraorbital nerve were identified emanating onto the face. The 2 branches entered separate osseous canals within the orbit to emerge via 2 infraorbital foramina. INTERVENTION: The unusual variation of the trigeminal nerve branch in the reported case necessitates a change in the way in which the nerve is blocked clinically. A common practice involves blocking the infraorbital nerve as it emerges from the infraorbital foramen. The needle is aimed superiorly, posteriorly, and slightly laterally; however, to provide adequate anesthesia to both branches of the infraorbital nerve, as reported here, a needle can be inserted between the zygomatic arch and the notch of the mandible in the pterygopalatine fossa. After the needle contacts the lateral pterygoid plate, it is withdrawn slightly and angled both superiorly and anteriorly to pass into the pterygopalatine fossa. CONCLUSION: Although apparently uncommon, such derangement of the infraorbital nerve should be kept in mind by surgeons during surgical procedures in the region for treatment of various disorders including trigeminal neuralgia.

Endoscopic Endonasal Anatomical Study of the Cavernous Sinus Segment of the Ophthalmic Nerve

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Ricardo Dolci ◽  
Ricardo Carrau ◽  
Lamia Buohliqah ◽  
Leo Filho ◽  
Mateo Zoli ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Anatomical Study ◽  
Endoscopic Endonasal

Endoscopic Endonasal Surgery for a Pterygopalatine Fossa Hydatid Cyst

2021 ◽  
Author(s):  
Vjerislav Peterković ◽  
Marcel Marjanović Kavanagh ◽  
Hrvoje Barić ◽  
Niko Njirić ◽  
Mirjana Balen-Topić ◽  
...  
Keyword(s):  
Hydatid Cyst ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal

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 Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Orbit

2021 ◽  
Author(s):  
Laura Salgado-Lopez ◽  
Luciano C. Leonel ◽  
Michael Obrien ◽  
Adedamola Adepoju ◽  
Michael J. Link ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Anatomy ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal
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