Endoscopic transpterygoid transmaxillary approach to the upper parapharyngeal space

LIU Quan; LIU Juan; WANG Huan; ZHANG Huan-Kang; SUN Xi-Cai; YU Hong-Meng

doi:10.16098/j.issn.0529-1356.2021.06.016

PDF(10236 KB)

Acta Anatomica Sinica ›› 2021, Vol. 52 ›› Issue (6) : 940-944. DOI: 10.16098/j.issn.0529-1356.2021.06.016

Anatomy

Endoscopic transpterygoid transmaxillary approach to the upper parapharyngeal space

LIU Quan LIU Juan WANG Huan ZHANG Huan-kang SUN Xi-cai* YU Hong-meng*

Author information +

History +

Abstract

Objective To present anatomical landmarks for endoscopic transpterygoid transmaxillary approach to the upper parapharyngeal space. Methods Anatomy of the upper parapharyngeal space using endoscopic endonasal transpterygoid transmaxillary approach was performed in cadaveric head. The distances between medial pterygoid plate, lateral pterygoid plate and styloid process were measured, respectively. The distances between lateral pterygoid plate, sphenoid spine and the entrance of carotid canal were also investigated. Results The dissection was performed in 10 fresh cadaver heads (20 sides). The distance between medial pterygoid plate, lateral pterygoid plate and styloid process were (28.1±3.3)mm and (18.9±4.9)mm respectively. The distances between lateral pterygoid plate, sphenoid spine and the entrance of carotid canal were (14.1±3.7)mm and (6.7±1.5)mm respectively. Pharyngobasilar fascia，medial pterygoid muscle and tensor veli palatini muscle were key landmarks of the upper parapharyngeal space. Conclusion The bone landmarks of lateral pterygoid plate and sphenoid spine are effective in identification of the entrance of carotid canal, which is helpful to locate the parapharyngeal segment of internal carotid artery.

Key words

Endoscopy / Parapharyngeal space / Internal carotid artery / Skull base / Anatomy / Human

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LIU Quan LIU Juan WANG Huan ZHANG Huan-kang SUN Xi-cai YU Hong-meng. Endoscopic transpterygoid transmaxillary approach to the upper parapharyngeal space[J]. Acta Anatomica Sinica. 2021, 52(6): 940-944 https://doi.org/10.16098/j.issn.0529-1356.2021.06.016

References

［1］ Zhi K, Ren W, Zhou H, et al. Management of parapharyngeal-space tumors［J］. J Oral Maxillofac Surg，2009，67(6):1239-1244.

［2］ Shirakura S, Tsunoda A, Akita K, et al. Parapharyngeal space tumors: anatomical and image analysis findings［J］. Auris Nasus Larynx，2010，37(5):621-625.

［3］ Chen HL, Sun GW, Tang EY, et al. Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors［J］. Chinese Journal of Stomatology, 2019, 54(2):107-111. (in Chinese)

陈昊亮, 孙国文, 唐恩溢, 等. 23例原发性咽旁间隙肿瘤的临床分析及手术方式探讨［J］. 中华口腔医学杂志, 2019, 54(2): 107-111.

［4］ Sun F, Yan Y, Wei D, et al. Surgical management of primary parapharyngeal space tumors in 103 patients at a single institution［J］. Acta Otolaryngol, 2018,138(1):85-89.

［5］ Wang J, Li WY, Yang DH, et al. Endoscope-assisted transoral approach for parapharyngeal space tumor resection［J］. Chin Med J (Engl), 2017,130(18):2267-2268.

［6］ Poletti AM, Dubey SP, Colombo G, et al. Surgical management of parapharyngeal space tumors: the role of cervical and lateral skull base approaches［J］. Ear Nose Throat J, 2016, 95(12):E1-E6.

［7］ Aghazadeh K, Mohammadtaghi K, Rikhtegar M, et al. Surgical approaches to benign parapharyngeal space tumors-5-year experience ［J］. Iran J Otorhinolaryngol,2020,32(108):43-48.

［8］ Wasano K, Yamamoto S, Tomisato S, et al. Modified endoscopic transnasal-transmaxillary-transpterygoid approach to parapharyngeal space tumor resection［J］. Head Neck, 2016,38(6):933-938.

［9］ Wang XM, Li H, Chen DSh, et al. The surgical management of upper parapharyngeal regions［J］. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2018,32(23):1804-1809. (in Chinese)

王晓敏, 李慧, 陈德尚, 等. 高位咽旁间隙良性肿瘤的手术治疗［J］.临床耳鼻咽喉头颈外科杂志, 2018, 32(23): 1804-1809.

［10］ Fan S, Lin SG, Zhang HQ, et al. A comparative study of the endoscopy-assisted transoral approach versus external approaches for the resection of large benign parapharyngeal space tumors［J］. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017,123(2):157-162.

［11］ Liu Q, Wang H, Zhao W, et al. Endoscopic transnasal transmaxillary approach to the upper parapharyngeal space and the skull base［J］. Eur Arch Otorhinolaryngol, 2020,277(3):801-807.

［12］ Sun X, Yan B, Truong HQ, et al. A comparative analysis of endoscopic-assisted transoral and transnasal approaches to parapharyngeal space: a cadaveric study［J］. J Neurol Surg B Skull Base,2018,79(3):229-240.

［13］ Van Rompaey J, Suruliraj A, Carrau R, et al. Access to the parapharyngeal space: an anatomical study comparing the endoscopic and open approaches［J］. Laryngoscope, 2013,123(10):2378-2382.

［14］ Dallan Ⅰ, Lenzi R, Bignami M, et al. Endoscopic transnasal anatomy of the infratemporal fossa and upper parapharyngeal regions: correlations with traditional perspectives and surgical implications［J］. Minim Invasive Neurosurg, 2010,53(56):261-269.

［15］ Joo W, Funaki T, Yoshioka F, et al. Microsurgical anatomy of the infratemporal fossa［J］. Clin Anat, 2013,26(4):455-469.

［16］ Paulsen F, Tillmann B, Christofides C, et al. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications［J］. J Anat,2000,197 (Pt 3):373-381.

［17］ Pfeiffer J, Ridder GJ. A clinical classification system for aberrant internal carotid arteries［J］. Laryngoscope,2008,118(11):1931-1936.

［18］ Wang C, Kundaria S, Fernandez-Miranda J, et al. A description of arterial variants in the transoral approach to the parapharyngeal space［J］. Clin Anat, 2014,27(7):1016-1022.

［19］ Li W, Chae R, Rubio RR, et al. Characterization of anatomical landmarks for exposing the internal carotid artery in the infratemporal fossa through an endoscopic transmasticator approach: a morphometric cadaveric study［J］. World Neurosurg, 2019,131:e415-e424.

［20］ Maheshwar AA, Kim EY, Pensak ML, et al. Roof of the parapharyngeal space: defining its boundaries and clinical implications［J］. Ann Otol Rhinol Laryngol, 2004,113(4):283-288.