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

2020 ◽  
Vol 133 (6) ◽  
pp. 1948-1959 ◽  
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.

Mini-invasive surgery of infratemporal fossa schwannomas

2015 ◽  
Vol 129 (2) ◽  
pp. 187-193 ◽  
Author(s):  
H Haidar ◽  
A Deveze ◽  
J P Lavieille
Keyword(s):  
Maxillary Sinus ◽  
Infratemporal Fossa ◽  
Posterior Wall ◽  
Endoscopic Approach ◽  
Surgical Approaches ◽  
Anatomical Location ◽  
Subtemporal Approach ◽  
Non Invasive ◽  
Transnasal Endoscopic Approach ◽  
Nerve Dysfunction

AbstractBackground:Infratemporal fossa schwannomas are benign, encapsulated tumours of the trigeminal nerve limited to the infratemporal fossa. Because of the complications and significant morbidity associated with traditional surgical approaches to the infratemporal fossa, which include facial nerve dysfunction, hearing loss, dental malocclusion and cosmetic problems, less invasive alternatives have been sought.Methods:This paper reports two cases of infratemporal fossa schwannomas treated in 2012 using mini-invasive approaches. The literature regarding different infratemporal fossa approaches was reviewed.Results:The first schwannoma was 30 mm in size and was removed completely by a preauricular subtemporal approach. The second one was 25 mm in size and was removed completely using a purely transnasal endoscopic approach. In both cases, there were no intra-operative or post-operative complications.Conclusion:These two approaches allow non-invasive and wide exposure of the infratemporal fossa as compared to classical approaches. Surgical approach should be selected according to the tumour's anatomical location with respect to the maxillary sinus posterior wall. The preauricular subtemporal approach is recommended for tumours localised posterolaterally with respect to the maxillary sinus posterior wall. Medial and anterior tumours near the maxillary sinus posterior wall can be best removed using a transnasal endoscopic approach.

Endoscopic Transnasal Study of the Infratemporal Fossa

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P76-P77
Author(s):  
Ross M. Germani ◽  
Islam Herzallah ◽  
Roy R Casiano
Keyword(s):  
Infratemporal Fossa ◽  
Middle Meningeal Artery ◽  
Video Camera ◽  
Masticatory Muscles ◽  
Point Of View ◽  
Endoscopic Approach ◽  
Foramen Rotundum ◽  
Anatomic Basis ◽  
Extended Endoscopic Approach ◽  
Neurovascular Structures

Objective 1)Introducing a new endoscopic orientation to the medial portion of the infratemporal fossa (ITF) which is not infrequently involved in sinonasal and related skull base pathologies. 2) Describing the anatomical details and measurement variations of some key ITF landmarks from the unique transnasal endoscopic perspective. Methods Using an extended endoscopic approach, the pterygopalatine and infratemporal fossae were dissected in 10 sides of 5 adult cadaver heads. After an extended transethmoid and transmaxillary approach, a plane of dissection along the pterygoid base and the infratemporal surface of the greater sphenoid wing was developed. The related masticatory muscles were dissected through the endoscopic approach. High quality images have been produced by coupling the video camera to a digital recording system. Results The foramen rotundum, ovale and spinosum were identified and new landmarks were described from the surgical endoscopic point of view. The sphenomandibularis muscle, recently named in anatomic literature, was also highlighted. Along with various neurovascular structures, the maxillary and mandibular divisions of the trigeminal nerve as well as the middle meningeal artery were identified. Columellar measurements to the foramen rotundum and ovale ranged from 6.1 to 8.0 cm for the former and 7.0 to 9.1 cm for the latter, with a mean of 6.75 cm and 7.78 cm respectively. Conclusions The current study provides a novel endo-scopic orientation to the medial ITF. Such knowledge should provide an anatomic basis for experienced surgeons to endo-scopically address this complex region with more safety and efficacy.

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.

scholarly journals Imaging of Dual Ophthalmic Arteries: Identification of the Central Retinal Artery

2014 ◽  
Vol 4 ◽  
pp. 40 ◽  
Author(s):  
Louise Louw ◽  
Johan Steyl ◽  
Eugene Loggenberg
Keyword(s):  
Carotid Artery ◽  
Clinical Problem ◽  
Middle Meningeal Artery ◽  
Central Retinal Artery ◽  
External Carotid ◽  
Maxillary Artery ◽  
Branching Pattern ◽  
Transfemoral Approach ◽  
Retinal Artery ◽  
Ophthalmic Arteries

Identification of the origin of the central retinal artery (CRA) is imperative in tailoring angiographic studies to resolve a given clinical problem. A case with dual ophthalmic arteries (OAs), characterized by different origins and distinct branching patterns, is documented for training purposes. Pre-clinical diagnosis of a 9-year-old child who presented with a sharp wire in the left-side eyeball was primarily corneal laceration. For imaging, a selected six-vessel angiographic study with the transfemoral approach was performed. Embolization was not required and the wire could be successfully removed. Right-side OA anatomy was normal, while left-side dual OAs with external carotid artery (ECA) and internal carotid artery (ICA) origins were seen. The case presented with a left-side meningo-ophthalmic artery (M-OA) anomaly via the ECA, marked by a middle meningeal artery (MMA) (origin: Maxillary artery; course: Through foramen spinosum) with normal branches (i.e. anterior and posterior branches), and an OA variant (course: Through superior orbital fissure) with a distinct orbital branching pattern. A smaller OA (origin: ICA; course: Through optic foramen) with a distinct ocular branching pattern presented with the central retinal artery (CRA). The presence of the dual OAs and the M-OA anomaly can be explained by disturbed evolutionary changes of the primitive OA and stapedial artery during development. The surgical interventionist must be aware of dual OAs and M-OA anomalies with branching pattern variations on retinal supply, because of dangerous extracranial–intracranial anastomotic connections. It is of clinical significance that the origin of the CRA from the ICA or ECA must be determined to avoid complications to the vision.

scholarly journals The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit—Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality

2021 ◽  
Vol 8 ◽  
Author(s):  
Alessandro Tel ◽  
Lorenzo Arboit ◽  
Salvatore Sembronio ◽  
Fabio Costa ◽  
Riccardo Nocini ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Minimally Invasive ◽  
Surgical Navigation ◽  
Virtual Endoscopy ◽  
Modern Technology ◽  
Endoscopic Approach ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Orbital Surgery ◽  
Endoscopic Techniques

In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training.

scholarly journals COURSE OF THE MAXILLARY ARTERY THROUGH THE LOOP OF THE AURICULOTEMPORAL NERVE. Recorrido de la arteria maxilar a través del bucle del nervio aurículotemporal

2016 ◽  
Vol 5 (3) ◽  
pp. 235-239
Author(s):  
Kavya Bhat ◽  
Sampath Madhyastha ◽  
Balakrishnan R
Keyword(s):  
Inferior Alveolar Nerve ◽  
Middle Meningeal Artery ◽  
Lingual Nerve ◽  
Maxillary Artery ◽  
Lateral Pterygoid Muscle ◽  
Male Cadaver ◽  
The Right ◽  
Unique Variation ◽  
Meningeal Artery ◽  
Auriculotemporal Nerve

Las variaciones en el curso de la arteria maxilar se describen a menudo, con sus relaciones con el músculo pterigoideo lateral. En el presente caso informamos una variación exclusiva en el curso de la arteria maxilar que no fue publicada antes. En un cadáver masculino de 75 años arteria maxilar derecho estaba pasando por el bucle del nervio auriculo-temporal. La arteria meníngea media provenía de la arteria maxilar con un bucle del nervio auriculo-temporal. La arteria maxilar pasaba profunda con respecto al nervio dentario inferior pero superficial al nervio lingual. El conocimiento de estas variaciones es importante para el cirujano y también serviría para explicar la posible participación de estas variaciones en la etiología del dolor mandibular. Variations in the course of the maxillary artery are often described with its relations to the lateral pterygoid muscle. In the present case we report a unique variation in the course of the maxillary artery which was not reported before. In a 75 years old male cadaver the right maxillary artery passed through the loop of the auriculotemporal nerve. The middle meningeal artery was arising from the maxillary artery within the nerve loop of auriculotemporal nerve. Further the maxillary artery passed deep to the inferior alveolar nerve but superficial to the lingual nerve. The knowledge of these variations is important for surgeons and it would also explain the possible involvement of these variations in etiology of the craniomandibular pain.

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.

scholarly journals Volumetric Analysis of Endoscopic and Maxillary Swing Surgical Approaches for Nasopharyngectomy

2018 ◽  
Vol 79 (05) ◽  
pp. 466-474 ◽  
Author(s):  
Nidal Muhanna ◽  
Harley Chan ◽  
Jimmy Qiu ◽  
Michael Daly ◽  
Tahsin Khan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Image Guidance ◽  
Parapharyngeal Space ◽  
Volumetric Analysis ◽  
Cone Beam ◽  
Surgical Approaches ◽  
Endoscopic Endonasal ◽  
Anatomical Structures ◽  
Volumetric Quantification ◽  
Maxillary Swing

Objectives/Hypothesis The endoscopic endonasal approach (EEA) for nasopharyngectomy is an alternative to the maxillary swing approach (MSA) for selected recurrent nasopharyngeal carcinomas (NPC). We compare the access between these approaches. Methods Three cadaver specimens were used to compare access volumes of the EEA and MSA. Exposure volumes were calculated using image guidance registration to cone beam computed tomography and tracking of accessible tissue with volumetric quantification. The area of exposure to the carotid artery was measured. Results The MSA provided higher volumes for access volume compared with the EEA (66.6 vs 39.1 cm3, p = 0.009). The working area was larger in the MSA (80.2 vs 56.9 cm2, p = 0.06). The exposure to the carotid artery was higher in the MSA (1.88 vs 1.62 cm2, p = 0.04). The MSA provided larger volume of exposure for tumors of the parapharyngeal space with exposure below the palate. Conclusions This study suggests that the MSA for nasopharyngectomy provides a larger volume of exposure. However, much of the increased exposure relates to exposure of the parapharyngeal space below the palate. The EEA provides adequate access to superior anatomical structures.

scholarly journals Transzygomatic anterior infratemporal fossa approach and high cervical approach for resection of infra temporal fossa and parapharyngeal space solitary fibrous tumours

2019 ◽  
pp. 492-497
Author(s):  
Kazumi Ohmori ◽  
Shiduka Kamiyoshi ◽  
Taku Takeuchi ◽  
Takanori Fukushima ◽  
Takashi Tsuduki ◽  
...  
Keyword(s):  
Parapharyngeal Space ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Surgical Approaches ◽  
Surgical Removal ◽  
Middle Fossa ◽  
Temporal Fossa ◽  
Solitary Fibrous Tumours ◽  
The 1960S ◽  
Superior Portion

The infratemporal fossa (ITF) is the region under the floor of the middle fossa giving passage to most major cerebral vessels and cranial nerves.(1) It is closely related to important adjacent regions such as the middle fossa, pterygopalatine fossa, orbit, and nasopharynx.(2) Due to the anatomical complexity in the ITF, surgical removal of the lesions in or around it is still challenging.(3) Since the 1960s, many surgeons have reported various surgical approaches. the preauricular transzygomatic approach via a transcranial route was reported to be used for exposure of the antero-superior portion of the ITF (2,3). Solitary fibrous tumours (SFTs) were first described by Klempere and Rabin in 1931 as spindle-cell tumours originating from the pleura.(4) With the exception of myopericytoma, infantile myofibromatosis and HPC-like lesions of the sinonasal tract showing myoid differentiation, all other HPC like lesions are best considered as subtypes of SFT.(5) Only a few cases of SFT have been described in the literature involving the skull base and parapharyngeal space.(6–8) The purpose of this article is to show anatomical dissections involving this surgical approach and to evaluate our surgical experience using it.

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