Middle ear microvascularization: an “in vivo” endoscopic anatomical study

Abstract

The vascular anatomy and BFD of the medial wall of the tympanic cavity can be easily studied in transcanal endoscopy. ITA (with a superior BFD in most cases) and ISA (with a main BFD from the incus to the stapes) are the most constant identifiable vessels.

Internal vascular channel architecture in human auditory ossicles

“…Because the vessels of the distal long process of the incus are subjected to surgical damage, there has been particular interest in the blood supply to this part of the ossicular chain (Alicandri‐Ciufelli et al, 2018 ; Lannigan et al, 1993b ). Its dual supply comprises both external mucosal and internal vessels.…”

The Middle Meningeal Artery: Branches, Dangerous Anastomoses, and Implications in Neurosurgery and Neuroendovascular Surgery

“…Foramen spinosum and the endocranial MMA trunk can be approximated based on the external anatomic landmark of the anterior edge of the root of the zygoma (Martínez et al, unpublished manuscript). Two branches originate from the main trunk (prebifurcation) of the MMA: (1) the cavernous artery, which supplies the lateral wall of the cavernous sinus and anastomoses with the inferolateral trunk of the cavernous ICA; and (2) the petrosal artery (Figure 5), which usually arises within 10 mm from the foramen spinosum and courses over the petrous apex near the lesser petrosal nerve, completely or partially covered ("protected") by bone and supplies the middle fossa floor, lateral cavernous sinus, trigeminal nerve and Gasserian ganglion (through the trigeminal branch), tensor tympani muscle and tympanic cavity (through the superior tympanic artery that anastomoses with the inferior tympanic artery [branch of the ascending pharyngeal artery], the caroticotympanic artery [branch of the petrous ICA and vestigial remnant of the hyoid artery], the anterior tympanic artery [branch of the maxillary artery], and the posterior tympanic artery [branch of the stylomastoid artery, which in turn is branch of the posterior auricular artery]), and the labyrinthine segment of the facial nerve (through its facial branch) 9,26 (Figure 5). The anterior division of the MMA can become intraosseous by entering a bony canal (of ∼1-30 mm in length) near the sphenoid angle of the parietal bone sometimes accompanied by the sphenoparietal sinus.…”

“…The external carotid artery(27) branches into the superficial temporal artery(31) and maxillary artery(30), which in turn gives the MMA (1). After entering the skull base through the foramen spinosum, the main trunk of the MMA (1) gives the following branches: the cavernous artery (4) that anastomoses with the inferolarteral trunk (7) of the cavernous ICA(26), which connects with the recurrent branch of the ophthalmic artery(24); the petrosal artery (5) that anastomoses with the APhA (8) and tentorial arteries (25) of the meningohypophyseal trunk; and the superior tympanic branch (6) that anastomoses into the middle ear with the inferior tympanic artery (9) of the APhA (8), the caroticotympanic (10) artery from the ICA, and with the posterior tympanic artery(11) from the posterior auricular artery(29). The MMA bifurcates into an anterior division (2) and a posterior division (3).…”