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Anatomical Study of Endoscopic Exposure of pterygopalatine fossa and Infra-temproal fossa via the Transnasal-Trans-perpendicularplate-palatine Approach or Transnasl Trans-maxillary-sinus Approach and Trans-canine-fossa Trans-maxillary-sinus Approach

Anatomical Study of Endoscopic Exposure of Pterygopalatine F...

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第十五届中国医师协会神经外科医师年会

Objective:The pterygopalatine fossa（PPF） and infratemproal fossa（ITF） were all the special area difficult to expose,and it was the great challenge to attack the lesions in these area in some conventional Skull-base approach.Demonstrate the endoscopic anatomy of pterygopalatine fossa（PPF） and infratemproal fossa（ITF） through three different approaches including the Transnasal Trans-perpendicularplate-palatine approach（TNTPA） or Transnasal Trans-maxillary sinus approach（TNTMA） or Trans-canine-fossa Trans-maxillary-sinus approach（TCTMA）,and evaluate the surgical exposure of PPF,ITF and MSF with the vascular or nerve structures in the three approaches for the optimal choice of the approach to the PPF or MSF in the clinical application.Methods:Seven silicone-injected cadaveric heads were dissection to explore the anatomic structures in the PPF and ITF through the endoscopic TNTPA,TNTMA or TCTMA.The exposure in these area was initiated using a 0-degree endoscope and followed by 30-degree endoscope.Computed tomography scan analysis and Neuronavigation were performed in all seven cadaveric heads to measureand compare the length of vessels and nerves and evaluate the exposed field in PPF and ITF in the three approaches precisely.Result:Anatomic dissection steps to access PPF,ITF and MCF in TNTPA,TNTMA or TCTMA were described.In the TNTPA,the medial part of PPF can be the mainly exposed under endoscopy.In the TNTMA,most part of PPF can be easily exposed by 0-degree endoscopy.The DPA,SPA,anterior deep temporal artery（ADTA）,ION,IOA,PSAA,PPG or GPN and lesser palatine nerve（IGN） could be all identified under 0 or 30-degree endoscopy.However,the inferior turbinate branch of SPA,PA and vidian nerve（VN） in medial PPF could not be found under 0-degree endoscopy,while medial part of vidian canal with vidian nerve can be partly drilled and exposed when lateral mobilize the structures in PPF with 30-degree endoscopy.In the TCTMA,the exposed field of PPF was similar to the TNTMA.Moreover,comparing the exposed area of the PPF in these

关键词： pterygopalatine fossa infra-temproal fossa Trans-nasal Trans-perpendicularplate-palatine approach Trans-nasal Trans-maxillary sinus approach Trans-canine fossa Trans-maxillary sinus approach Endoscopy

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Three-hundred and sixty degrees of surgical approaches to the maxillary sinus

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第1期8卷 42-53页

作者： Natalia C.Rezende Carlos D.Pinheiro-Neto Luciano C.P.C.Leonel Jamie J.Van Gompel Maria Peris-Celda Garret Choby Division of Rhinology and Skull Base Surgery Department of Otolaryngology-Head&Neck SurgeryMayo ClinicRochesterMinnesotaUSA Department of Neurologic Surgery Mayo ClinicRochesterMinnesotaUSA

Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS.The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially(endoscopic maxillary antrostomy and ethmoidectomy),anteriorly(Caldwell-Luc),superiorly(transconjunctival/transorbital approach),inferiorly(transpalatal approach),and posterolaterally(preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS.Surgeons should be familiar with indications,limitations,and surgical anatomy from different perspectives to approach the MS.This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.

关键词： anatomy Caldwell-Luc dissection endoscopic sinus surgery infratemporal fossa maxillary sinus pterygopalatine fossa

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