Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space

Lemos-Rodriguez, Ana M.; Sreenath, Satyan B.; Rawal, Rounak B.; Overton, Lewis J.; Farzal, Zainab; Zanation, Adam M.

doi:10.1002/lary.25781

Cited by 35 publications

(3 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surgical approaches to the parapharyngeal space (PPS) include the transoral, transcervical, transparotid, transmandibular, and a combination of the above; each approach has its advantages and disadvantages. [2][3][4] The prevalent benign nature of PPTs should prompt the ideal gold standard approach of completely removing the mass leaving no remnants while also minimizing postsurgical functional and aesthetic sequelae. The transoral approach is the most consistent with the above principles.…”

Section: Introductionmentioning

confidence: 99%

Transoral Endoscopic Localization of the Parapharyngeal Internal Carotid Artery

Zhang

Zhao

Sun

et al. 2021

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Objectives To define transoral endoscopic surgical landmarks for the parapharyngeal segment of the internal carotid artery (ppICA) using cadaveric dissection. Materials and Methods Ten fresh cadaveric heads were dissected to demonstrate the parapharyngeal space anatomy and course of the ppICA as seen in a transoral approach. Anatomical measurements of the distance between the ppICA and bony landmarks were recorded and analyzed. Results The stylohyoid ligament, styloglossus, and stylopharyngeus could be considered to be the safe anterior boundary of the ppICA in the transoral approach; among them, the styloid ligament was the most rigid tissue. Dissection between the stylopharyngeus muscle and superior pharyngeal constrictor muscle provides direct access to the ppICA. At the level of the skull base, the distance from the root of the styloid process to the lateral margin of the external aperture of the carotid canal on the left side and on the right side was 8.57 ± 1.97 and 8.80 ± 1.21 mm, respectively. At the level of the maxillary tuberosity, the distance from the ppICA to the maxillary tuberosity on the left side and on the right side was 31.48 ± 2.24 and 31.01 ± 2.88 mm, respectively. Conclusion The endoscopic-assisted transoral approach can facilitate exposure of the ppICA. The root of the styloid process, styloid ligament, and maxillary tuberosity are critical landmarks in the identification of the ppICA in the transoral approach.

show abstract

Section: Introductionmentioning

confidence: 99%

Transoral Endoscopic Localization of the Parapharyngeal Internal Carotid Artery

Zhang

Zhao

Sun

et al. 2021

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

show abstract

“…For the same reasons, whenever imaging and/or cytology suggests the benign nature of a PPT, a "wait and see" policy may also be adopted in asymptomatic or slow-growing lesions, especially in patients with severe comorbidities. 5,[12][13][14][15][16][17] The purpose of this preclinical study is to compare the main surgical approaches to the PPS based on systematic cadaver dissection and navigation-based quantification of surgical corridors. [5][6][7][8][9] In addition, several technical refinements, such as endoscope-assisted dissection, intraoperative neuromonitoring, and debrider-assisted cavitation, were introduced to minimize surgical morbidity without affecting radicality of resection.…”

Section: Introductionmentioning

confidence: 99%

“…4,10,11 Although some attempts have been made to systematize the choice of the surgical approach in relation to the target, an objective description of advantages and limitations of the different surgical routes to PPS is lacking. 5,[12][13][14][15][16][17] The purpose of this preclinical study is to compare the main surgical approaches to the PPS based on systematic cadaver dissection and navigation-based quantification of surgical corridors.…”

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of the parapharyngeal space: Multiperspective, quantification‐based study

et al. 2018

View full text Add to dashboard Cite

Background Several surgical approaches to the parapharyngeal space (PPS) have been proposed. An objective description of advantages and limitations of the surgical routes is lacking. Methods Ten cadaver heads were dissected using the transnasal (medial, lateral), sublabial, transoral (transpharyngeal, transvestibular, transmandibular), transcervical (transcervical, transparotid, transmandibular, transmastoid), and type C and D infratemporal approaches. Neurovascular and musculoskeletal structures encountered were analyzed. A navigation‐based quantification of working volume and exposure of PPS compartments was accomplished. Results Transnasal approaches exposed the upper PPS, though with limited working volume. Transoral approaches exposed the middle PPS, minimizing neurovascular structures crossed. Only transcervical and skull base approaches exposed the entire PPS, crossing several neurovascular structures. Conclusion A tentative systematization of the surgical approach(es) to PPS in relation to different targets is provided: unicompartmental resection can be performed with a single, conservative access, whereas multicompartmental dissections frequently require a wider or multiportal approach.

show abstract