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Anatomical Variations and Relationships of the Infratemporal Fossa: Foundation of a Novel Endonasal Approach to the Foramen Ovale

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机构: [1]Capital Med Univ, Beijing Tongren Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China [2]Ohio State Univ, James Canc Hosp, Dept Otolaryngol Head & Neck Surg, Wexner Med Ctr, Columbus, OH 43210 USA [3]Johns Hopkins Sch Med, Dept Otolaryngol Head & Neck Surg, Baltimore, MD USA [4]Natl Inst Deafness & Other Commun Disorders, Sinonasal & Skull Base Tumor Program, NIH, Bethesda, MD USA [5]Ohio State Univ, James Canc Hosp, Dept Neurol Surg, Wexner Med Ctr, Columbus, OH 43210 USA
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关键词: infratemporal fossa lateral pterygoid plate foramen ovale V-3 internal maxillary artery

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Objective Access to the infratemporal fossa (ITF) is complicated by its complex neurovascular relationships. In addition, copious bleeding from the pterygoid plexus adds to surgical challenge. This study aims to detail the anatomical relationships among the internal maxillary artery (IMA), pterygoid plexus, V (3,) and pterygoid muscles in ITF. Furthermore, it introduces a novel approach that displaces the lateral pterygoid plate (LPP) to access the foramen ovale. Design and Main Outcome Measures Six cadaveric specimens (12 sides) were dissected using an endonasal approach to the ITF modified by releasing and displacing the LPP and lateral pterygoid muscle (LPTM) as a unit. Subperiosteal elevation of the superior head of LPTM revealed the foramen ovale. The anatomic relationships among the V (3) , pterygoid muscles, pterygoid plexus, and IMA were surveyed. Results In 9/12 sides (75%), the proximal IMA ran between the temporalis and the LPTM, whereas in 3/12 sides (25%), the IMA pierced the LPTM. The deep temporal nerve was a consistent landmark to separate the superior and inferior heads of LPTM. An endonasal approach displacing the LPP in combination with a subperiosteal elevation of the superior head of LPTM provided access to the posterior trunk of V (3) and foramen ovale while sparing injury of the LPTM and exposing the pterygoid plexus. The anterior trunk of V (3) traveled anterolaterally along the greater wing of sphenoid in all specimens. Conclusion Displacement of the LPP and LPTM provided direct exposure of foramen ovale and V (3) avoiding dissection of the muscle and pterygoid plexus; thus, this maneuver may prevent intraoperative bleeding and postoperative trismus.

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出版当年[2020]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 外科
最新[2025]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 外科
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出版当年[2019]版:
Q3 SURGERY Q4 CLINICAL NEUROLOGY
最新[2023]版:
Q3 SURGERY Q4 CLINICAL NEUROLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2019版] 出版当年五年平均 出版前一年[2018版] 出版后一年[2020版]

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第一作者机构: [1]Capital Med Univ, Beijing Tongren Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China [2]Ohio State Univ, James Canc Hosp, Dept Otolaryngol Head & Neck Surg, Wexner Med Ctr, Columbus, OH 43210 USA
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通讯机构: [2]Ohio State Univ, James Canc Hosp, Dept Otolaryngol Head & Neck Surg, Wexner Med Ctr, Columbus, OH 43210 USA [5]Ohio State Univ, James Canc Hosp, Dept Neurol Surg, Wexner Med Ctr, Columbus, OH 43210 USA [*1]Ohio State Univ, James Canc Hosp, Dept Neurol Surg, Dept Otolaryngol Head & Neck Surg,Wexner Med Ctr, Starling Loving Hall Room B221,614-685-6778, Columbus, OH 43210 USA
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