Endoscopic transpterygoid nasopharyngectomy: Correlation of surgical anatomy with multiplanar CT

Abstract

Understanding the anatomy-based endoscopic modular approaches facilitates planning and safe execution of an oncologic nasopharyngectomy. Clinical experience remains mandatory because anatomic models fall short of clinical scenarios.

Landmarks for endoscopic approach to the parapharyngeal internal carotid artery: A radiographic and cadaveric study

“…The pterygoid process is identified and commonly drilled out during the endoscopic transpterygoid and infratemporal fossa approach . Moreover, the lateral aspect of the pterygoid process is found in the same sagittal trajectory as the ppICA, whereby further dissection from the lateral pterygoid process in a posterior direction will lead to the ppICA. The posteromedial border of the mandible was used as a landmark because it is roughly in the same coronal plane as the ppICA and would provide a reference point for the ppICA in this plane.…”

“…Although they require specialized surgical skills and instrumentation, they have the potential to minimize postoperative morbidity. Recently, endoscopic access to the parapharyngeal space and infratemporal fossa has been described . What is crucial in these approaches is the anatomy of the internal carotid artery, which takes a complicated, tortuous course through this area.…”

“…Very few reports have specifically described the transnasal endoscopic anatomy for management of the parapharyngeal segment of the internal carotid artery (ppICA) . Using information obtained from computed tomography (CT) angiographic studies and cadaveric dissection, we sought to define bony landmarks that could potentially aid in the identification of the ppICA.…”

Surgical landmarks of the nasopharyngeal internal carotid using the maxillary swing approach: A cadaveric study

“…Surgery of the retrostyloid space (RSS) and of the infratemporal fossa (ITF) is increasingly done endoscopically . Some teams prefer open techniques, arguing better visual control, such as the maxillary swing approach .…”

“…Some teams prefer open techniques, arguing better visual control, such as the maxillary swing approach . However, both use an anterior approach and share the same major risk laterally, the internal carotid artery (ICA), which has a very close relationship with the nasopharyngeal wall . Although the intrapetrous, paraclival, and parasellar portions of the ICA have clear surgical landmarks due to their fixed position in the bony canals, the paranasopharyngeal portion, which is surrounded by soft tissue, does not have reliable surgical landmarks and is always hazardous to find.…”