Modular Endoscopic Medial Maxillectomies: Quantitative Analysis of Surgical Exposure in a Preclinical Setting

Schreiber, Alberto; Ferrari, Marco; Rampinelli, Vittorio; Doglietto, Francesco; Belotti, Francesco; Lancini, Davide; Ravanelli, Marco; Rodella, Luigi Fabrizio; Fontanella, Marco Maria; Nicolai, Piero

doi:10.1016/j.wneu.2016.12.094

Cited by 28 publications

(25 citation statements)

References 12 publications

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“…The infraorbital, posterior superior alveolar, and buccal nerves were never sacrificed intentionally. Twelve (92.3%) patients underwent a type B EMM, whereas in the remainder, a type C EMM was performed . Type D EMM (i.e., Sturmann‐Canfield procedure) was never performed.…”

Section: Resultsmentioning

confidence: 99%

“…Twelve (92.3%) patients underwent a type B EMM, whereas in the remainder, a type C EMM was performed. 7 Type D EMM (i.e., Sturmann-Canfield procedure) was never performed.…”

Section: Resultsmentioning

confidence: 99%

“…The surgical technique for TER of JA has been previously reported by our group in numerous publications . The procedure usually starts with posterior septectomy and removal of the sphenoidal rostrum and endoscopic medial maxillectomy (EMM), which is modulated depending on the lateral extension of the JA in the infratemporal fossa . Total ethmoidectomy, opening of the descending palatine canal, and removal of the medial portion of the posterior maxillary wall allows exposure of the JA behind the periosteum of the pterygopalatine and infratemporal fossae.…”

Section: Methodsmentioning

confidence: 99%

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Long‐term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma

Mattavelli¹,

Rampinelli²,

Ferrari³

et al. 2018

The Laryngoscope

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Objectives/Hypothesis Although transnasal endoscopic resection (TER) of juvenile angiofibroma (JA) is unquestionably less invasive than traditional external approaches, several endonasal and neurovascular structures are sacrificed during the procedure. The aim of this study was to evaluate long‐term neurological morbidity and related quality of life following TER of JA. Study Design Retrospective cohort study. Methods All patients who underwent TER for JA at the Unit of Otorhinolaryngology–Head and Neck Surgery of the University of Brescia from 1994 to 2016 were contacted to know their availability to undergo a battery of tests aimed to assess lacrimal secretion (Schirmer test), impairment of sensitive nerves (electrophysiological threshold test), and impact on quality of life of tearing reduction and sensitivity impairment with the Ocular Surface Disease Index (OSDI) and visual analogue scale (VAS) (0–10), respectively. Results Thirteen patients were included. Mean follow‐up was 77 months (range, 19–156 months). The median Schirmer test value was 5.5 mm and 28.5 mm for the treated and untreated sides, respectively (P = .003). Analysis of sensitivity revealed significant impairment only in the hard palate. The mean OSDI score was 6.8 (normal). The mean values of the VAS scores for hard palate, buccal mucosa, gum, and premaxillary skin were 1.7, 1.7, 1.2, and 2.3, respectively. Conclusions TER for JA can result in objective reduction of lacrimal secretion and sensitivity impairment; nevertheless, their impact on quality of life is negligible. The predictable neurological morbidity of TER should be discussed during preoperative counseling. Level of Evidence 4 Laryngoscope, 129:2184–2188, 2019

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Section: Resultsmentioning

confidence: 99%

“…Twelve (92.3%) patients underwent a type B EMM, whereas in the remainder, a type C EMM was performed. 7 Type D EMM (i.e., Sturmann-Canfield procedure) was never performed.…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Long‐term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma

Mattavelli¹,

Rampinelli²,

Ferrari³

et al. 2018

The Laryngoscope

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“…Medial transnasal-transantral approach (MTN) After performing a type D endoscopic medial maxillectomy, 18 the perpendicular process of the palatine bone, the medial pterygoid plate, and the cranial portion of the medial pterygoid muscle were removed. The eustachian tube was dissected from the tensor veli palatini muscle, levator veli palatini muscle, and fibrous tissue connecting the cartilage to the skull base and sectioned at the bony-cartilaginous junction ( Figure 1A).…”

Section: Anterior Approachesmentioning

confidence: 99%

“…[18][19][20][21][22] Deep surfaces of the surgical corridor were tracked by drawing with a navigated probe the perimeter of the exposed portion of the prevertebral space (for anterior approaches) or lateral pharyngeal wall (for lateral approaches). The quantification method has been previously validated by our group for quantification of skull base approaches.…”

Section: Quantificationmentioning

confidence: 99%

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

et al. 2018

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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.

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Anterior superior alveolar nerve injury after extended endoscopic medial maxillectomy: a preclinical study to predict neurological morbidity

Schreiber

Mattavelli

Ferrari

et al. 2017

Int Forum Allergy Rhinol

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Modular Endoscopic Medial Maxillectomies: Quantitative Analysis of Surgical Exposure in a Preclinical Setting

Cited by 28 publications

References 12 publications

Long‐term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma

Long‐term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma

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

Anterior superior alveolar nerve injury after extended endoscopic medial maxillectomy: a preclinical study to predict neurological morbidity

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